Provider Demographics
NPI:1538384003
Name:FALLON, THEODORE JAMES JR (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:FALLON
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425-0081
Mailing Address - Country:US
Mailing Address - Phone:610-827-7436
Mailing Address - Fax:610-827-0962
Practice Address - Street 1:1050 KING OF PRUSSIA RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2830
Practice Address - Country:US
Practice Address - Phone:610-827-7436
Practice Address - Fax:610-827-7436
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028700E207R00000X, 2084P0800X, 2084P0804X, 102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry