Healthcare Provider Details

I. General information

NPI: 1346312717
Provider Name (Legal Business Name): STEPHEN S FALKENBERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/30/2019
Certification Date: 12/30/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLINTON ST
WOONSOCKET RI
02895-3207
US

IV. Provider business mailing address

235 PLAIN STREET SUITE 204
PROVIDENCE RI
02905
US

V. Phone/Fax

Practice location:
  • Phone: 17-674-1004
  • Fax:
Mailing address:
  • Phone: 401-453-4242
  • Fax: 401-453-0832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD08802
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD08802
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD08002
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: