Provider Demographics
NPI:1447241757
Name:FALLICA, CAROLYN L (NP)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:L
Last Name:FALLICA
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:41 MONTVALE AVE
Mailing Address - Street 2:HALLMARK HEALTH HEMATOLOGY & ONCOLOGY CENTER
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2445
Mailing Address - Country:US
Mailing Address - Phone:781-224-5810
Mailing Address - Fax:781-224-5813
Practice Address - Street 1:41 MONTVALE AVE
Practice Address - Street 2:HALLMARK HEALTH HEMATOLOGY & ONCOLOGY CENTER
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2445
Practice Address - Country:US
Practice Address - Phone:781-224-5810
Practice Address - Fax:781-224-5813
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2013-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA143363363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1200992Medicaid
Q14750Medicare UPIN
MA1200992Medicaid