Provider Demographics
NPI:1609872282
Name:BLACK, JOHN ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1025 MEDICAL CENTER DR
Mailing Address - Street 2:DELANEY RADIOLOGISTS GROUP, PLLC
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401
Mailing Address - Country:US
Mailing Address - Phone:910-763-1800
Mailing Address - Fax:910-763-6419
Practice Address - Street 1:1025 MEDICAL CENTER DR
Practice Address - Street 2:DELANEY RADIOLOGISTS GROUP, PLLC
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401
Practice Address - Country:US
Practice Address - Phone:910-763-1800
Practice Address - Fax:910-763-6419
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC284632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7901897Medicaid
NC8901898Medicaid
AB3281627OtherDEA
NC204307Medicare PIN
213378AMedicare ID - Type Unspecified
NC24302Medicare PIN
NC8901898Medicaid