Provider Demographics
NPI:1114969193
Name:FALCK, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:FALCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAROLYN CT
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-1653
Mailing Address - Country:US
Mailing Address - Phone:410-368-2014
Mailing Address - Fax:410-368-3575
Practice Address - Street 1:900 CATON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5201
Practice Address - Country:US
Practice Address - Phone:410-368-2014
Practice Address - Fax:410-368-3575
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47353207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00196901OtherRAILROAD MEDICARE
MD60609101OtherBLUE CROSS
MD242861000Medicaid
MD180MJ823Medicare ID - Type Unspecified
MD242861000Medicaid