Provider Demographics
NPI:1871585489
Name:BLACK, LEHMAN ERNEST III (MD)
Entity type:Individual
Prefix:MR
First Name:LEHMAN
Middle Name:ERNEST
Last Name:BLACK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2564 MARSHALL WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-3520
Mailing Address - Country:US
Mailing Address - Phone:916-812-4410
Mailing Address - Fax:
Practice Address - Street 1:2825 CAPITOL AVE RM 1S118
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6039
Practice Address - Country:US
Practice Address - Phone:916-887-0104
Practice Address - Fax:916-887-0104
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-12-02
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Provider Licenses
StateLicense IDTaxonomies
CAG644722080P0203X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA006644720Medicaid
D16120Medicare UPIN