Provider Demographics
NPI:1790097939
Name:FALK, KEVIN G (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:G
Last Name:FALK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:
Other - Last Name:FALK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2010 W 38TH ST UPPR LVL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2004
Practice Address - Country:US
Practice Address - Phone:814-866-6835
Practice Address - Fax:814-866-6837
Is Sole Proprietor?:No
Enumeration Date:2010-07-03
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015830204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029752180001Medicaid
PA1029752180015Medicaid
PA1029752180001Medicaid