Provider Demographics
NPI:1811952740
Name:FALLER, NANCY IRENE (DO)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:IRENE
Last Name:FALLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 KIMEL PARK DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6984
Mailing Address - Country:US
Mailing Address - Phone:336-765-6181
Mailing Address - Fax:336-765-8492
Practice Address - Street 1:145 KIMEL PARK DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6984
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-765-8492
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401402208VP0000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13736OtherBLUE CROSS & BLUE SHIELD
NC8931096Medicaid
NCD8837OtherMEDCOST
NC05609128OtherAETNA
NCQ46993AMedicare PIN
NC05609128OtherAETNA
NC2210212GMedicare ID - Type Unspecified