Provider Demographics
NPI:1790883379
Name:FALKE, ROBERTA M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:M
Last Name:FALKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:
Practice Address - Street 1:133 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3904
Practice Address - Country:US
Practice Address - Phone:617-421-5950
Practice Address - Fax:617-421-6008
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA80056207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0014961OtherNEIGHBORHOOD HEALTH PLAN
MAPM596OtherHARVARD PILGRIM
MA4291399-001OtherCIGNA
MAC04913OtherBLUE CROSS
MA0144185Medicaid
MAPM596OtherHARVARD PILGRIM
MA0144185Medicaid