MEDICARE: FALLAN SAVAGE

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	363LF0000X	Family Nurse Practitioner	L1-0040949	DE
2	363LF0000X	Family Nurse Practitioner	LG-0000883	DE
3	363LF0000X	Family Nurse Practitioner	SP015691	PA
4	363LF0000X	Family Nurse Practitioner	AC001796	MD

General Provider Information

NPI Number	:	1477935625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FALLAN SAVAGE

Provider Business Mailing Address
First Line	:	603 VALENCIA CT
Second Line	:
City	:	TOWNSEND
State	:	DE
Zip	:	19734-3048
Country	:	US
Telephone Number	:	484-557-7759
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 CENTERVILLE RD
Second Line	:	SUITE 400
City	:	WILMINGTON
State	:	DE
Zip	:	19808-1660
Country	:	US
Telephone Number	:	800-370-3651
Fax Number	:	877-515-7147

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

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	11/02/2016

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Directions to “ FALLAN SAVAGE ” Practice Location

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