Healthcare Provider Details

I. General information

NPI: 1033107883
Provider Name (Legal Business Name): CRAIG ROBERT FAULKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 WASHINGTON CIR NW SUITE 404
WASHINGTON DC
20037-2356
US

IV. Provider business mailing address

3 WASHINGTON CIR NW SUITE 404
WASHINGTON DC
20037-2356
US

V. Phone/Fax

Practice location:
  • Phone: 202-333-2820
  • Fax: 202-833-1410
Mailing address:
  • Phone: 202-333-2820
  • Fax: 202-833-1410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD19275
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: