Black, Jason W

Black, Jason W is an individual health care provider with primary practice located at 6701 N Charles St Ste 4105, Baltimore MD 21204-6808. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is his primary health care specialty. Black, Jason W can be contacted via phone (443) 849-3184.

Contact Information

Primary practice address
6701 N Charles St Ste 4105 Baltimore MD 21204-6808
Phone: (443) 849-3184
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X D61199 Maryland
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X D61199 Maryland

Profile Details

NPI number 1245259902
LBN Legal business name Black, Jason W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2006
Last updated Dec 21st, 2011 - about 13 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1245259902 NPPES
Maryland Other S1380079 CAREFIRST REGIONAL GBMC
Maryland MEDICAID 405540300 CAREFIRST REGIONAL GBMC
Maryland Other KJ15/64265301 CAREFIRST REGIONAL GBMC

Popular Providers