Provider Demographics
NPI:1558363846
Name:FALLON, BARBARA G (MD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:G
Last Name:FALLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-3999
Mailing Address - Country:US
Mailing Address - Phone:860-224-6254
Mailing Address - Fax:860-832-4378
Practice Address - Street 1:300 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3916
Practice Address - Country:US
Practice Address - Phone:860-224-6254
Practice Address - Fax:860-832-4378
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029598207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004062394Medicaid
CT367807OtherWELLCARE MEDICARE
CT4377459OtherAETNA REF ID
CTHAS407OtherHEALTH NET PROV ID
CT010029598CT02OtherBCBS N BCFP PROV ID
CT720988OtherCONNECTICARE PROV ID
CT2V3633OtherHEALTH NET PROV ID
CT001295981Medicaid
CT0029365OtherCIGNA PROV ID
CT1255448155OtherGHMC GROUP NPI
CTC01373Medicare ID - Type UnspecifiedGHMC GROUP MEDICARE ID
CT010029598CT02OtherBCBS N BCFP PROV ID
CT2V3633OtherHEALTH NET PROV ID
CT004062394Medicaid