Mr Darryll W Black, PA-C is a
Physician Assistant based in Wright-patterson Afb, Ohio. Mr Darryll W Black is licensed to practice in Indiana (license number 10002023A) and his current practice location is
88 Mdg, 4881 Sugar Maple Dr, Wright-patterson Afb, Ohio. He can be reached at his office (for appointments etc.) via phone at
(937) 257-6569.
NPI number for Mr Darryll W Black is 1679735138 and his current mailing address is 88 Mdg, 4881 Sugar Maple Dr, Wright-patterson Afb, Ohio. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1679735138.
Provider's Profile
| Full Name | Mr Darryll W Black |
|---|
| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 88 Mdg, Wright-patterson Afb, Ohio |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1679735138
- Provider Enumeration Date: 06/26/2008
- Last Update Date: 04/11/2018
Medical Identifiers
Medical identifiers for Mr Darryll W Black such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1679735138 | NPI | - | NPPES |
| 0171202 | Medicaid | OH | |
| OPR | Medicaid | IN | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 10002023A (Indiana) | Primary |
| 363AS0400X | Physician Assistant - Surgical | MA053346 (Pennsylvania) | Secondary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Darryll W Black is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Darryll W Black, PA-C
88 Mdg, 4881 Sugar Maple Dr,
Wright-patterson Afb, OH 45433-5529
Ph: (937) 257-6569 | Mr Darryll W Black, PA-C
88 Mdg, 4881 Sugar Maple Dr,
Wright-patterson Afb, OH 45433-5529
Ph: (937) 257-6569 |
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