Provider Demographics
NPI:1972516193
Name:FALLON, ROBERT D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:FALLON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:55 HIGHLAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2185
Mailing Address - Country:US
Mailing Address - Phone:978-740-2300
Mailing Address - Fax:978-744-3993
Practice Address - Street 1:55 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2100
Practice Address - Country:US
Practice Address - Phone:978-740-2300
Practice Address - Fax:978-744-3993
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2010-07-01
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Provider Licenses
StateLicense IDTaxonomies
MA31276207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA489050OtherCIGNA
5091477OtherAETNA
MA0126209Medicaid
MA65625OtherHARVARD PILGRIM
MAD17029OtherBLUE CROSS BLUE SHIELD
MA0406457OtherUNITED HEALTH CARE
MA702522OtherTUFTS
MA0406457OtherUNITED HEALTH CARE
D17049Medicare PIN