Basic Information
Provider Information | |||||||||
NPI: | 1689994105 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SAWYER FALCON | ||||||||
FirstName: | MELISSA | ||||||||
MiddleName: | L.A. | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SAWYER | ||||||||
OtherFirstName: | MELISSA | ||||||||
OtherMiddleName: | L.A. | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DO | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 2500 MARYLAND RD | ||||||||
Address2: | STE 400 | ||||||||
City: | WILLOW GROVE | ||||||||
State: | PA | ||||||||
PostalCode: | 190901225 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2157625030 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2300 COMPUTER RD STE H39 | ||||||||
Address2: |   | ||||||||
City: | WILLOW GROVE | ||||||||
State: | PA | ||||||||
PostalCode: | 190901740 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2156575200 | ||||||||
FaxNumber: | 2156578083 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/07/2010 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | OS016528 | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
ID | Type | State | Issuer | Description | 102858721 | 05 | PA |   | MEDICAID |