Provider Demographics
NPI:1811096977
Name:FALLA, PEDRO C (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:C
Last Name:FALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BRIGHAM ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-2208
Mailing Address - Country:US
Mailing Address - Phone:508-979-1100
Mailing Address - Fax:508-979-1918
Practice Address - Street 1:54 BRIGHAM ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-2208
Practice Address - Country:US
Practice Address - Phone:508-979-1100
Practice Address - Fax:508-979-1918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3200604Medicaid
MA3200604Medicaid
MAA29357Medicare ID - Type Unspecified