Healthcare Provider Details

I. General information

NPI: 1548056708
Provider Name (Legal Business Name): ALEXANDER J FALLER PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9825 KENWOOD RD STE 105
BLUE ASH OH
45242-6252
US

IV. Provider business mailing address

9825 KENWOOD RD STE 105
BLUE ASH OH
45242-6252
US

V. Phone/Fax

Practice location:
  • Phone: 833-364-5588
  • Fax:
Mailing address:
  • Phone: 833-364-5588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010357RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: