Mr Darryll W Black, PA-C | |
88 Mdg, 4881 Sugar Maple Dr, Wright-patterson Afb, OH 45433-5529 | |
(937) 257-6569 | |
Not Available |
Full Name | Mr Darryll W Black |
---|---|
Gender | Male |
Speciality | Physician Assistant |
Location | 88 Mdg, Wright-patterson Afb, Ohio |
Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1679735138 | NPI | - | NPPES |
0171202 | Medicaid | OH | |
OPR | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363A00000X | Physician Assistant | 10002023A (Indiana) | Primary |
363AS0400X | Physician Assistant - Surgical | MA053346 (Pennsylvania) | Secondary |
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 |
Matthew Caiano, Physician Assistant Medicare: Medicare Enrolled Practice Location: 88 Mdg/sghj 4881 Sugar Maple Dr, Wright-patterson Afb, OH 45433 Phone: 937-713-3556 |