Provider Demographics
NPI:1396740544
Name:FALLON, PATRICK J (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:FALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:690 MINOT AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-3922
Mailing Address - Country:US
Mailing Address - Phone:207-783-1328
Mailing Address - Fax:207-795-0260
Practice Address - Street 1:690 MINOT AVE
Practice Address - Street 2:STE 1
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-3922
Practice Address - Country:US
Practice Address - Phone:207-783-1328
Practice Address - Fax:207-795-0260
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME013805207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0378600001OtherDMERC
100294000OtherUSPS WC
1044480OtherAETNA
010416156OtherTRAVELERS/CORE/MEDNET
ME314430099OtherMAINECARE
200044523OtherRR MEDICARE
201017OtherMEDICARE ASC FACILITY
MM0716OtherMEDICARE CLINIC FACILITY
043465OtherANTHEM
MM583301OtherNEW MEDICARE PTAN
4229509OtherCIGNA
173418OtherHARVARD
MM5833OtherMEDICARE
201017OtherMEDICARE ASC FACILITY