David L Black, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

MA000813L Issued in PA

Practice address

4310 Londonderry Rd
Suite 202
Harrisburg, PA 17109-5300

Phone

(717) 920-7664

Fax

(717) 920-4361

NPI assigned

Sep 9, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582070400000",
    "number": "1427042092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 S LINCOLN AVE",
            "city": "LEBANON",
            "state": "PA",
            "postal_code": "170427529",
            "telephone_number": "717-272-6621",
            "fax_number": "717-228-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 LONDONDERRY RD",
            "address_2": "SUITE 202",
            "city": "HARRISBURG",
            "state": "PA",
            "postal_code": "171095300",
            "telephone_number": "717-920-7664",
            "fax_number": "717-920-4361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "DAVID",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-09",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "PA",
            "license": "MA000813L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "0993475",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "50041402",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Bivens
• Sarah Bixler
• Aunyail Black
• Barbara A Black, DPM
• David Detweiler Black, DMD
• Saralynn Black, COTA
• William Edward Black, D.M.D.
• Ashley Blaha
• Sally Ann Blaine, MD
• Angela Blair

• Surgical Physician Assistant in Harrisburg, PA
• Providers in Harrisburg, PA by specialty
• Surgical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.