Provider Demographics
NPI:1972671733
Name:BLACK, ANGELA PILCHER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:PILCHER
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1010 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-4937
Mailing Address - Country:US
Mailing Address - Phone:512-396-0680
Mailing Address - Fax:512-396-9836
Practice Address - Street 1:601B LEAH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7849
Practice Address - Country:US
Practice Address - Phone:512-392-1700
Practice Address - Fax:512-396-8743
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL6792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147758001Medicaid
TX147758001Medicaid