Black, Harold Micagah

Black, Harold Micagah is an individual health care provider with primary practice located at 3600 Joseph Siewick Dr , Fairfax VA 22033-1709. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Black, Harold Micagah can be contacted via phone (703) 391-3129.

Contact Information

Primary practice address
3600 Joseph Siewick Dr Fairfax VA 22033-1709
Phone: (703) 391-3129
Fax: (703) 295-9369
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 0024070513 Virginia

Profile Details

NPI number 1831198084
LBN Legal business name Black, Harold Micagah
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2005
Last updated Sep 9th, 2008 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1831198084 NPPES
Virginia Other 139180 ANTHEM
Virginia MEDICAID 1831198084 ANTHEM
Virginia Other 298077 ANTHEM
Virginia Other K142-0002 ANTHEM

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