Healthcare Provider Details

I. General information

NPI: 1154646248
Provider Name (Legal Business Name): MARSHALL COLIN FAULDS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE BLDG 19, FLOOR 2, ORTHOPEDICS
BETHESDA MD
20889-0004
US

IV. Provider business mailing address

8901 WISCONSIN AVE BLDG 19, FLOOR 2, ORTHOPEDICS
BETHESDA MD
20889-0004
US

V. Phone/Fax

Practice location:
  • Phone: 301-319-8777
  • Fax:
Mailing address:
  • Phone: 301-319-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2014-14
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: