Provider Demographics
NPI:1275380719
Name:FALLON, THOMAS ANTHONY (ADT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:FALLON
Suffix:
Gender:M
Credentials:ADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43031 MEGAN LN
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-3530
Mailing Address - Country:US
Mailing Address - Phone:240-577-9752
Mailing Address - Fax:
Practice Address - Street 1:26845 POINT LOOKOUT RD STE 1
Practice Address - Street 2:
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-4935
Practice Address - Country:US
Practice Address - Phone:240-577-9752
Practice Address - Fax:443-440-5780
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDADT3515101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)