Most Relevant Information
Provider Data
| NPI Number: | 1003815267 |
| Provider Name: | GLORIA GILBERT BLACK CRNA |
| Entity Type: | Individual |
| Taxonomy Code: | 207L00000X |
| Specialty: | Anesthesiology |
| License Number: | 0024076529 |
Most Important Dates
| Enumeration Date: | 07/19/2005 |
| Last Updated: | 02/21/2019 |
Provider Practice Location
3600 JOSEPH SIEWICK DR
FAIRFAX
VA
220331709
Practice Location Phone/Fax
| Phone: | 7032959360 |
| Fax: | 7032959369 |
Provider Mailing Location
PO BOX 37090
BALTIMORE
MD
212973090
Provider Mailing Phone/Fax
| Phone: | 7032959360 |
| Fax: | 7032959369 |