Healthcare Provider Details

I. General information

NPI: 1558363846
Provider Name (Legal Business Name): BARBARA G FALLON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3916
US

IV. Provider business mailing address

300 KENSINGTON AVE
NEW BRITAIN CT
06051-3999
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-6254
  • Fax: 860-832-4378
Mailing address:
  • Phone: 860-224-6254
  • Fax: 860-832-4378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number029598
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: