Provider Demographics
NPI:1043231152
Name:GRAHAM FALLON MD
Entity Type:Organization
Organization Name:GRAHAM FALLON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:FALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-828-5151
Mailing Address - Street 1:6701 N CHARLES ST
Mailing Address - Street 2:SUITE 4202
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6808
Mailing Address - Country:US
Mailing Address - Phone:410-828-5151
Mailing Address - Fax:410-825-1837
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 4202
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:410-828-5151
Practice Address - Fax:410-825-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0018660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD777741800Medicaid
MD777741800Medicaid
MD3125FGMedicare PIN