Basic Information
| Provider Information | |||||||||
| NPI: | 1174985519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | ASBURY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 WALNUT BOTTOM RD | ||||||||
| Address2: | |||||||||
| City: | SHIPPENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172578131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175320175 | ||||||||
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| Practice Location | |||||||||
| Address1: | 127 WALNUT BOTTOM RD | ||||||||
| Address2: | |||||||||
| City: | SHIPPENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172578131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175320175 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2016 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD468172 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.