| Dr Colleen Rochelle Black, MD | |
|
6555 Kee Ln Ste 200, Harrisburg, NC 28075-7463 | |
| (704) 316-6140 | |
| (704) 316-6141 |
| Full Name | Dr Colleen Rochelle Black |
|---|---|
| Gender | Female |
| Speciality | Pediatrics |
| Location | 6555 Kee Ln Ste 200, Harrisburg, North Carolina |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508032194 | NPI | - | NPPES |
| 5916285 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208000000X | Pediatrics | 2008-00927 (North Carolina) | Primary |
| Entity Name | Novant Health Medical Group, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1366409492 PECOS PAC ID: 1153234893 Enrollment ID: O20031121000692 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Colleen Rochelle Black, MD Po Box 60447, Charlotte, NC 28260-0447 Ph: (844) 266-8268 | Dr Colleen Rochelle Black, MD 6555 Kee Ln Ste 200, Harrisburg, NC 28075-7463 Ph: (704) 316-6140 |
Carol J Soucie, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6555 Kee Ln Ste 200, Harrisburg, NC 28075 Phone: 704-316-6140 Fax: 704-316-6141 | |
Amirah Lachaune Shareef, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5427 Nc Highway 49 S, Ste 103, Harrisburg, NC 28075 Phone: 704-455-5565 | |
Marianna Gagina, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 5427 Nc Highway 49 S, Ste 103, Harrisburg, NC 28075 Phone: 704-455-5565 | |
Geetika Gupta, MD Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 5427 Nc Highway 49 S, Ste 103, Harrisburg, NC 28075 Phone: 704-455-5565 | |
Erica Lauren Jones, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 5427 Nc Highway 49 S, Ste 103, Harrisburg, NC 28075 Phone: 704-455-5565 | |
Jubayer Ahmed, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6555 Kee Ln Ste 200, Harrisburg, NC 28075 Phone: 704-316-6140 Fax: 704-316-6141 |