Individual provider · Type 1 NPI

Angelique V. Black, PA

Medical Physician Assistant · Reston, VA

NPI number 1932127644 Active

Practice location

1850 Town Center Parkway, Suite 400
Reston, VA 20190

Fax (703) 787-9664

Mailing address

11240 Waples Mill Road, Suite 403
Fairfax, VA 22030

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X0110002122 (VA)

Medical Physician Assistant: Definition to come...

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About NPI 1932127644

Angelique V. Black, PA's National Provider Identifier is 1932127644, issued on Jul 18, 2006. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Reston, VA. The record was last updated on Jul 8, 2007.