Provider Demographics
NPI:1285624387
Name:BLACK, BARBARA A (DPM)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:BLACK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 LYNDHURST RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-3016
Mailing Address - Country:US
Mailing Address - Phone:717-880-1318
Mailing Address - Fax:717-741-5762
Practice Address - Street 1:1821 FULTON ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17102-1522
Practice Address - Country:US
Practice Address - Phone:717-232-9971
Practice Address - Fax:717-230-3914
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002964L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA562755OtherBLUE SHIELD
PA1175727Medicaid
T89743Medicare UPIN
PA1175727Medicaid