Bruce Charles Black, M.D.

Primary specialty

Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X

License

53793 Issued in MA

Practice address

372 Washington St
Wellesley, MA 02481-6202

Phone

(781) 239-3550

Fax

(781) 239-3272

NPI assigned

Aug 13, 2006

Last updated

Jan 15, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263513600000",
    "number": "1770595217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "372 WASHINGTON ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024816202",
            "telephone_number": "781-239-3550",
            "fax_number": "781-239-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "372 WASHINGTON ST",
            "city": "WELLESLEY",
            "state": "MA",
            "postal_code": "024816202",
            "telephone_number": "781-239-3550",
            "fax_number": "781-239-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRUCE",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2010-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MA",
            "license": "53793",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MA",
            "license": "53793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS HEALTH PLAN",
            "identifier": "053793",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MA",
            "identifier": "J04142",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bio-Medical Applications of Massachusetts, Inc. (Fresenius Kidney Care Wellesley)
• Birch Hill Behavioral Health, PLLC
• Diane Bird, NP
• Nathan Simcha Birnbaum, DDS CAGS
• Ann Bitetti
• Marnita Netalia Blackwell-Washington
• Glen S Blair, CNP
• Emily Blake
• Lauren R Blakely, PHD
• Iphigenie T Blanc

• Child & Adolescent Psychiatry Physician in Wellesley, MA
• Providers in Wellesley, MA by specialty
• Child & Adolescent Psychiatry Physician in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.