Healthcare Provider Details

I. General information

NPI: 1831038413
Provider Name (Legal Business Name): ISAAC BENJAMIN FALCONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL
BOSTON MA
02118-2908
US

IV. Provider business mailing address

2036 MASSACHUSETTS AVE APT 1
CAMBRIDGE MA
02140-2128
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8000
  • Fax:
Mailing address:
  • Phone: 720-416-7749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: