MEDICARE: EDMUND FRANCIS FALLON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	108707	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00402828	OTHER	NY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003860354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND FRANCIS FALLON

Provider Business Mailing Address
First Line	:	PO BOX 304
Second Line	:
City	:	GLENS FALLS
State	:	NY
Zip	:	12801-0304
Country	:	US
Telephone Number	:	518-926-6992
Fax Number	:	518-926-6983

Provider Business Practice Location Address
First Line	:	135 NORTH RD
Second Line	:
City	:	WILTON
State	:	NY
Zip	:	12831-1308
Country	:	US
Telephone Number	:	518-581-7256
Fax Number	:	518-926-1965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	06/03/2008

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Directions to “ EDMUND FRANCIS FALLON ” Practice Location

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