Provider Demographics
NPI:1053825323
Name:FAULWELL, THOMAS SAID
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:SAID
Last Name:FAULWELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 GEORGE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5489
Mailing Address - Country:US
Mailing Address - Phone:805-404-0361
Mailing Address - Fax:
Practice Address - Street 1:59 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-2047
Practice Address - Country:US
Practice Address - Phone:805-404-0361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-25
Last Update Date:2017-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT714171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty