Angelique V Black, PA
Physician Assistant, Medical in Reston, VA. Individual provider (NPI-1).
NPI number1932127644
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1932127644
- Entity type
- Individual (NPI-1)
- Name
- Angelique V Black
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 18, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AM0700X | Physician Assistant, Medical | 0110002122 | VA | Yes |
Practice location
1850 Town Center ParkwaySuite 400
Reston, VA 20190
Phone 703-689-0300 · Fax 703-787-9664
Mailing address
11240 Waples Mill RoadSuite 403
Fairfax, VA 22030
Phone 703-246-8080 · Fax 703-691-4932
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