Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | LP03090 | RI |
N | 111NI0900X | Internist | LP03090 | RI |
Y | 207RH0003X | Hematology & Oncology | 130636 | OH |
NPI | 1063826188 |
---|---|
Provider Name | Jaleh Fallah |
First Address | Cleveland, OH 44195-0001 |
Second Address | Pawtucket, RI 02860-4474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2014 |
Last Update Date | 20/07/2017 |