Basic Information
| Provider Information | |||||||||
| NPI: | 1023657780 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LABARGE | ||||||||
| FirstName: | FALLON | ||||||||
| MiddleName: | MARLENE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3599 VINEYARD HAVEN DR APT B | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451403672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124803246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 33300 CLEVELAND CLINIC BLVD | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440111172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4406955000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2019 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 50.006224RXO | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.