Provider Demographics
NPI:1922469279
Name:VICTORIA L FALCONE, DO LLC
Entity Type:Organization
Organization Name:VICTORIA L FALCONE, DO LLC
Other - Org Name:FALCONE CENTER FOR FUNCTIONAL COSMETIC AND INTEGRATIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FALCONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-213-5323
Mailing Address - Street 1:191 PRESIDENTIAL BLVD STE B104
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1216
Mailing Address - Country:US
Mailing Address - Phone:215-586-3304
Mailing Address - Fax:
Practice Address - Street 1:191 PRESIDENTIAL BLVD STE B104
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1216
Practice Address - Country:US
Practice Address - Phone:215-586-3304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012047261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center