Healthcare Provider Details

I. General information

NPI: 1225398241
Provider Name (Legal Business Name): KATHERINE FALLANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 N CHARLES ST STE 302
BALTIMORE MD
21204-5804
US

IV. Provider business mailing address

6565 N CHARLES ST STE 302
BALTIMORE MD
21204-5804
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-9225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD457183
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberD0083124
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: