Black, Mary Ellen
Black, Mary Ellen is an individual health care provider with primary practice located at 3509 Nw Samaritan Dr , Corvallis OR 97330-3766. She recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as her primary health care specialty. Black, Mary Ellen can be contacted via phone (541) 768-5235.Contact Information
Primary practice address
3509 Nw Samaritan Dr
Corvallis OR 97330-3766
Phone: (541) 768-5235
Fax: (541) 768-5201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | MD25360 | Oregon |
Profile Details
| NPI number | 1528264207 |
|---|---|
| LBN Legal business name | Black, Mary Ellen |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1528264207 | NPPES |
| Oregon | MEDICAID | 022804 |
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