Provider Demographics
NPI:1407826845
Name:FALLON, BRIAN ANDREW (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ANDREW
Last Name:FALLON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 E. 68TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4709
Mailing Address - Country:US
Mailing Address - Phone:912-355-4557
Mailing Address - Fax:912-355-3186
Practice Address - Street 1:803 E. 68TH STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4709
Practice Address - Country:US
Practice Address - Phone:912-355-4557
Practice Address - Fax:912-355-3186
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005952-1213ES0103X
GAPOD001202213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02542836Medicaid
NY02542836Medicaid
NYU96847Medicare UPIN