Basic Information
| Provider Information | |||||||||
| NPI: | 1447782842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLACK | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | CARROLL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8916 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | BLUE ASH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452427814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132837451 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4777 E GALBRAITH RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452362725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136865446 | ||||||||
| FaxNumber: | 5136866868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2017 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 58.029802 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.