Provider Demographics
NPI:1619971058
Name:FALK, JASON BARRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:BARRY
Last Name:FALK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-3319
Mailing Address - Country:US
Mailing Address - Phone:508-990-0211
Mailing Address - Fax:508-991-3404
Practice Address - Street 1:41 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-3319
Practice Address - Country:US
Practice Address - Phone:508-990-0211
Practice Address - Fax:508-991-3404
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1620213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA001620OtherSECURE HORIZONS PROV. ID
MA0344222Medicaid
MA33030OtherHARVARD PILGRIM PROV. ID
MA27-01027OtherUNITED HEALTH PROV. ID
MAY70709OtherBC/BS PROVIDER NUMBER
MA23428OtherB.M.C. HEALTHNET PROV. ID
MA001620OtherSECURE HORIZONS PROV. ID
MA0344222Medicaid