Provider Demographics
NPI:1720042252
Name:FALASCO, NORBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:
Last Name:FALASCO
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 1:6900 TURKEY LAKE RD STE 1-1
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4707
Mailing Address - Country:US
Mailing Address - Phone:407-370-9783
Mailing Address - Fax:407-370-9784
Practice Address - Street 1:6900 TURKEY LAKE RD STE 1-1
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-370-9783
Practice Address - Fax:407-370-9784
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43769208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105129000Medicaid
FL002740900Medicaid
FL0804034OtherCIGNA
FL59274OtherAVMED
FL690062OtherWELLCARE