Black, Darryll W.

Black, Darryll W. is an individual health care provider with primary practice located at 88 Mdg 4881 Sugar Maple Dr, Wright-Patterson Afb OH 45433-5529. He recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Black, Darryll W. can be contacted via phone (937) 257-6569.

Contact Information

Primary practice address
88 Mdg 4881 Sugar Maple Dr Wright-Patterson Afb OH 45433-5529
Phone: (937) 257-6569
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10002023A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X MA053346 Pennsylvania

Profile Details

NPI number 1679735138
LBN Legal business name Black, Darryll W.
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 26th, 2008
Last updated Apr 11th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1679735138 NPPES
Ohio MEDICAID 0171202
Ohio MEDICAID OPR

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