Kevin Hale Black, DDS, MD in Charlotte, NC - Medicare Student in an Organized Health Care Education/Training Program Provider

Kevin Hale Black, DDS, MD is a medicare enrolled "Student In An Organized Health Care Education/training Program" provider in Charlotte, North Carolina. His current practice location is 1000 Blythe Blvd, Charlotte, North Carolina. You can reach out to his office (for appointments etc.) via phone at (704) 355-2000.

Kevin Hale Black is licensed to practice in * (Not Available) (license number ) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1003995085.

Contact Information

	Kevin Hale Black, DDS, MD
	1000 Blythe Blvd, Charlotte, NC 28203-5812
	(704) 355-2000
	Not Available

Healthcare Provider's Profile

Full Name	Kevin Hale Black
Gender	Male
Speciality	Student In An Organized Health Care Education/training Program
Location	1000 Blythe Blvd, Charlotte, North Carolina
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1003995085
Provider Enumeration Date: 11/02/2006
Last Update Date: 03/28/2022

Medicare PECOS Information:

PECOS PAC ID: 2466820261
Enrollment ID: I20221129002499

Medical Identifiers

Medical identifiers for Kevin Hale Black such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1003995085	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223G0001X	Dentist - General Practice	19705 (Texas)	Secondary
390200000X	Student In An Organized Health Care Education/training Program	(* (Not Available))	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kevin Hale Black is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kevin Hale Black, DDS, MD Po Box 32861, Charlotte, NC 28232-2861 Ph: (704) 355-2000	Kevin Hale Black, DDS, MD 1000 Blythe Blvd, Charlotte, NC 28203-5812 Ph: (704) 355-2000

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Kevin Hale Black, DDS, MD - Medicare in Charlotte, NC