Provider Demographics
NPI:1265529788
Name:BLACK, NANCY BURGESS (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:BURGESS
Last Name:BLACK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:CREDENTIALS COORDINATORS WALTER REED ARMY MEDICAL CTR
Mailing Address - Street 2:ATTN MCHL MAOC 6900 GEORGIA AVE NW
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20307-0001
Mailing Address - Country:US
Mailing Address - Phone:202-782-3321
Mailing Address - Fax:
Practice Address - Street 1:CREDENTIALS COORDINATORS WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:ATTN MCHL MAO C 6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD 82572084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry