Provider Demographics
NPI:1568418945
Name:OFALLON, DENIS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DENIS
Middle Name:JOHN
Last Name:OFALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12123 MERRICKS CT
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:MD
Mailing Address - Zip Code:21770-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 RESEARCH BLVD
Practice Address - Street 2:350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3164
Practice Address - Country:US
Practice Address - Phone:301-838-9606
Practice Address - Fax:301-838-9029
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD066751000Medicaid
601285800OtherFECA
MD015638F85Medicare ID - Type UnspecifiedGROUP G01485
B37263Medicare UPIN
MD839MK223Medicare ID - Type UnspecifiedGROUP 839M