MEDICARE: DR. RONALD HARLAN FALCON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	167970-1	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
10	070008110	OTHER		PALMETTO GBA/RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	13452	OTHER	GHI
2	8226207006	OTHER	CIGNA
3	18988	OTHER	MASTERCARE
4	2C8726	OTHER	HEALTH NET
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0458774	OTHER	AETNA/USHC/PRUCARE
7	13364	OTHER	UNITED HEALTHCARE
8	36E771	OTHER	BCBS
9	AS172	OTHER	OXFORD
11	23718	OTHER	VYTRA

General Provider Information

NPI Number	:	1801853965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD HARLAN FALCON M.D.

Provider Business Mailing Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-889-5681

Provider Business Practice Location Address
First Line	:	604 E PARK AVE
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2505
Country	:	US
Telephone Number	:	516-432-0011
Fax Number	:	516-889-5681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2006
Last Update Date	:	01/03/2013

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Directions to “ DR. RONALD HARLAN FALCON M.D.” Practice Location

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