Provider Demographics
NPI:1588613129
Name:BLACK, ENGLISH B I (PAC)
Entity Type:Individual
Prefix:
First Name:ENGLISH
Middle Name:B
Last Name:BLACK
Suffix:I
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ENGLISH
Other - Middle Name:LEE
Other - Last Name:BAKER GLAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:4010 MENDENHALL OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8076
Mailing Address - Country:US
Mailing Address - Phone:336-887-3195
Mailing Address - Fax:336-887-3194
Practice Address - Street 1:4010 MENDENHALL OAKS PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8076
Practice Address - Country:US
Practice Address - Phone:336-887-3195
Practice Address - Fax:336-887-3194
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19680363AM0700X
NC0001-04013363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2760634OtherMEDICARE ID
P64216Medicare UPIN
NC2760634OtherMEDICARE ID