Provider Demographics
NPI:1164488581
Name:FALCO, GENNARO A (MD)
Entity Type:Individual
Prefix:
First Name:GENNARO
Middle Name:A
Last Name:FALCO
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 1:438 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-432-5563
Mailing Address - Fax:607-432-2437
Practice Address - Street 1:438 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-432-5563
Practice Address - Fax:607-432-2437
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139920208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
24800024811OtherMVP VENDOR NUMBER
NY00854866Medicaid
107135OtherWELLCARE
GF063F3320OtherDOWN MEDICARE
000000007135OtherGHI HMO
100149715671OtherCDPHP GROUP NUMBER
2504533OtherCHI PPO
340001215OtherRR MEDICARE
100149715671OtherCDPHP GROUP NUMBER
B82492Medicare UPIN