Provider Demographics
NPI:1750603551
Name:FALLON-KLINE FOOT & ANKLE ASSOCIATES
Entity type:Organization
Organization Name:FALLON-KLINE FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:FALLON
Authorized Official - Last Name:KLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:484-597-0440
Mailing Address - Street 1:2591 BAGLYOS CIR
Mailing Address - Street 2:C 53
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8043
Mailing Address - Country:US
Mailing Address - Phone:484-544-5044
Mailing Address - Fax:484-544-8955
Practice Address - Street 1:2591 BAGLYOS CIR
Practice Address - Street 2:C 53
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8043
Practice Address - Country:US
Practice Address - Phone:484-544-5044
Practice Address - Fax:484-544-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005941213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1024772890001Medicaid
PA6502500001Medicare NSC
PA183416Medicare PIN
V10465Medicare UPIN