Provider Demographics
NPI:1396700613
Name:BLACK, MARCUS L (MD)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:L
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3600 PRYTANIA ST
Mailing Address - Street 2:STE 35
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3628
Mailing Address - Country:US
Mailing Address - Phone:504-897-8315
Mailing Address - Fax:504-891-9862
Practice Address - Street 1:519 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4311
Practice Address - Country:US
Practice Address - Phone:504-324-9024
Practice Address - Fax:504-373-6807
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA05701R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1326313Medicaid
B60252Medicare UPIN
LA5J010F818Medicare PIN
LA5J010Medicare PIN