Provider Demographics
NPI:1841365889
Name:FALL, CHRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:FALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 NORTH COMMONS BLVD
Mailing Address - Street 2:F11A
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143
Mailing Address - Country:US
Mailing Address - Phone:440-446-7677
Mailing Address - Fax:440-395-0163
Practice Address - Street 1:300 NORTH COMMONS BLVD
Practice Address - Street 2:F11A
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143
Practice Address - Country:US
Practice Address - Phone:440-446-7677
Practice Address - Fax:440-395-0163
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35078930207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2240177Medicaid
OH2240177Medicaid
OHFA4050161Medicare ID - Type Unspecified