Provider Demographics
NPI:1942710884
Name:BLACK, MARGARET KATHRYN (NP)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:KATHRYN
Last Name:BLACK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5536 GAUMER AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1708
Mailing Address - Country:US
Mailing Address - Phone:856-986-2857
Mailing Address - Fax:
Practice Address - Street 1:151 FRIES MILL RD STE 104
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2056
Practice Address - Country:US
Practice Address - Phone:856-312-3057
Practice Address - Fax:856-437-5619
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP017399363LA2200X
NJ26NJ00729600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health