IndividualActive
Angelique Black, PA
NPI 1932127644 · Medical Physician Assistant · Reston, VA
Provider details
- NPI number
- 1932127644
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PA
- Sex
- Female
- Sole proprietor
- No
- License
- 0110002122 (VA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
1850 Town Center Parkway
Suite 400
Reston, VA 20190
Phone: (703) 689-0300
Fax: (703) 787-9664
Approximate (ZIP-level) locationGet directions
Mailing address
11240 Waples Mill Road
Fairfax, VA 22030
Registry dates
- Enumerated
- 2006-07-18
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.