Provider Demographics
NPI:1144423542
Name:FAUCI, JANELLE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:MARIE
Last Name:FAUCI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 QUEENS RD STE 540
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:980-302-6560
Practice Address - Fax:980-302-6565
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01015207VG0400X, 207VX0201X
AL29244207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051116596OtherBCBS
AL128474Medicaid
AL128468Medicaid
AL051116590OtherBCBS
AL051116591OtherBCBS
AL051116592OtherBCBS
AL128470Medicaid
AL051116594OtherBCBS
NC1144423542Medicaid
AL128475Medicaid
AL051116593OtherBCBS
AL128471Medicaid
AL128473Medicaid
MS01905778Medicaid
AL051116595OtherBCBS
AL128472Medicaid
AL128473Medicaid