Provider Demographics
NPI:1477935625
Name:SAVAGE, FALLAN
Entity Type:Individual
Prefix:
First Name:FALLAN
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 VALENCIA CT
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:DE
Mailing Address - Zip Code:19734-3048
Mailing Address - Country:US
Mailing Address - Phone:484-557-7759
Mailing Address - Fax:
Practice Address - Street 1:2711 CENTERVILLE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1660
Practice Address - Country:US
Practice Address - Phone:800-370-3651
Practice Address - Fax:877-515-7147
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0040949363LF0000X
DELG-0000883363LF0000X
PASP015691363LF0000X
MDAC001796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily