Provider Demographics
NPI:1932460664
Name:FALCO, MARK HODGSON (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:HODGSON
Last Name:FALCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3016 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1973
Mailing Address - Country:US
Mailing Address - Phone:702-780-7118
Mailing Address - Fax:702-895-4014
Practice Address - Street 1:1707 W CHARLESTON BLVD STE 190
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2352
Practice Address - Country:US
Practice Address - Phone:702-671-5110
Practice Address - Fax:702-384-6592
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NV21063208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program