Provider Demographics
NPI:1609816883
Name:FALLON, JOHN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:FALLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:36 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1333
Mailing Address - Country:US
Mailing Address - Phone:781-334-6121
Mailing Address - Fax:
Practice Address - Street 1:BLUE CROSS BLUE SHIELD OF MA,
Practice Address - Street 2:401 PARK DR.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3326
Practice Address - Country:US
Practice Address - Phone:617-246-3392
Practice Address - Fax:617-246-3817
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA36815207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine