Provider Demographics
NPI:1578558474
Name:BLACK, QUINTEN C (MD)
Entity Type:Individual
Prefix:
First Name:QUINTEN
Middle Name:C
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:445 BILTMORE AVE
Practice Address - Street 2:SUITE G-102
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4565
Practice Address - Country:US
Practice Address - Phone:828-253-7077
Practice Address - Fax:828-253-6898
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2003-007472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC134JJOtherBCBS OF NC PROVIDER #
NCC8226OtherMEDCOST PROVIDER #
NC7685722OtherAETNA PROVIDER NUMBER
NCP00037555OtherRAILROAD MCARE PROV. #
NC0554569001OtherCIGNA PROVIDER NUMBER
FL1190946OtherGATEWAY HEALTH
NC36-00363OtherUTD. HLTHCR PROVIDER #
NC89134JJMedicaid
NCC8226OtherMEDCOST PROVIDER #
NCP00037555OtherRAILROAD MCARE PROV. #