Provider Demographics
NPI:1558636373
Name:DIFALCO, JENNIFER HALL (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HALL
Last Name:DIFALCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:ALICE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:111 TORREY ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4800
Mailing Address - Country:US
Mailing Address - Phone:508-588-1200
Mailing Address - Fax:
Practice Address - Street 1:111 TORREY ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4800
Practice Address - Country:US
Practice Address - Phone:508-588-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79433207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine