Provider Demographics
NPI:1245234764
Name:FALLON, EDWARD C (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:C
Last Name:FALLON
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 1:301 S 7TH AVE
Mailing Address - Street 2:STE 135
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1442
Mailing Address - Country:US
Mailing Address - Phone:484-628-8108
Mailing Address - Fax:484-628-8400
Practice Address - Street 1:301 S 7TH AVE
Practice Address - Street 2:STE 135
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1442
Practice Address - Country:US
Practice Address - Phone:484-628-8108
Practice Address - Fax:484-628-8400
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-013890-E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA104622GGYOtherMEDICARE
PA0688030Medicaid
PA104622GGYOtherMEDICARE