Provider Demographics
NPI:1184777609
Name:FALVELLO, CHRISTINA G (PA-C,ATC)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:G
Last Name:FALVELLO
Suffix:
Gender:F
Credentials:PA-C,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:54 WEST BENJAMIN AVE
Mailing Address - City:CONYNGHAM
Mailing Address - State:PA
Mailing Address - Zip Code:18219-0654
Mailing Address - Country:US
Mailing Address - Phone:570-956-4946
Mailing Address - Fax:
Practice Address - Street 1:54 WEST BENJAMIN AVE
Practice Address - Street 2:
Practice Address - City:CONYNGHAM
Practice Address - State:PA
Practice Address - Zip Code:18219-0654
Practice Address - Country:US
Practice Address - Phone:570-956-4946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001842363AS0400X
PAMA053974363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT970002298Medicare PIN