Deborah Naomi Black, MD

Key facts

NPI

1770622896

Entity type

Individual (NPI type 1)

Primary specialty

Neurology Physician 2084N0400X

License

042 0009704 (VT)

Practice address

130 Fisher Rd
Mob-a Suite 1
Berlin, VT 05602-9516

Phone

(802) 225-5650

Fax

(802) 225-5651

NPI assigned

Feb 5, 2007

Sex

Female

Sole proprietor

No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central Vermont Medical Center Inc Family Medicine Physician · Berlin, VT · NPI 1023028784
  Medicare reassignment NPD NEUROLOGY · VT
• University of Vermont Medical Center Inc Internal Medicine Physician · Burlington, VT · NPI 1659309615
  Medicare reassignment NPD VT

Medicare participation

Medicare fee-for-service enrollment

Enrolled in VT

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 14, 2015.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1770622896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 547",
            "address_2": "ATT: CVMC FINANCE DEPT",
            "city": "BARRE",
            "state": "VT",
            "postal_code": "056410547",
            "telephone_number": "802-225-5650",
            "fax_number": "802-225-5651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 FISHER RD",
            "address_2": "MOB-A SUITE 1",
            "city": "BERLIN",
            "state": "VT",
            "postal_code": "056029516",
            "telephone_number": "802-225-5650",
            "fax_number": "802-225-5651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "DEBORAH",
        "middle_name": "NAOMI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VT",
            "license": "042 0009704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "OVN1845",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN LINKED TO CVMC",
            "identifier": "VN184503",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, VT

• Marc Belisle
• Berlin Enhanced Senior Living LLC
• Christine T Bernardine, RN
• Kate Best, FNP
• Paule Bezaire Dussault, LICSW
• Jared Andrew Blum, M.D.
• Glenn Bomberger, LADC
• Courtney Lynn Borland, APRN
• Michael Bouchard II, DPM
• Keith J Breasure, MSN,NP

All providers in Berlin, VT · Neurology Physician in Vermont