Healthcare Provider Details

I. General information

NPI: 1720042252
Provider Name (Legal Business Name): NORBERT FALASCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 TURKEY LAKE RD STE 1-1
ORLANDO FL
32819
US

IV. Provider business mailing address

6900 TURKEY LAKE RD STE 1-1
ORLANDO FL
32819-4707
US

V. Phone/Fax

Practice location:
  • Phone: 407-370-9783
  • Fax: 407-370-9784
Mailing address:
  • Phone: 407-370-9783
  • Fax: 407-370-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME43769
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME43769
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: