Provider Demographics
NPI:1548221476
Name:FALLIS, NEAL M (MD)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:M
Last Name:FALLIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:ATTN PHYSICIAN SERVICES WOT 12TH FLOOR
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-5529
Mailing Address - Fax:
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:WOT 12TH FL
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-2038
Practice Address - Country:US
Practice Address - Phone:508-852-0600
Practice Address - Fax:508-853-7149
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2011-05-03
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Provider Licenses
StateLicense IDTaxonomies
MA46539207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110174997OtherRAILROAD MEDICARE
784131OtherMVP HEALTH CARE
N01884OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
9900027OtherFALLON COMMUNITY HEALTH P
26805OtherHEALTHY START
AA1201OtherHARVARD PILGRIM HEALTHCAR
N01884OtherBLUE SHIELD INDEMNITY
N01884OtherMEDICARE B
0400879OtherEVERCARE
MA3099385Medicaid
5673270OtherCIGNA HEALTH PLAN
917679OtherFIRST HEALTH
3099385OtherMEDICAID WELFARE
7799613OtherAETNA US HEALTHCARE
042472266OtherHEALTHCARE VALUE MANAGMEN
N01884OtherBLUE CARE ELECT
3099385OtherMEDICAID WELFARE
AA1201OtherHARVARD PILGRIM HEALTHCAR