Provider Demographics
NPI:1275537649
Name:FALKENBERG, THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:FALKENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CHATHAM HEIGHTS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2566
Mailing Address - Country:US
Mailing Address - Phone:540-371-2777
Mailing Address - Fax:540-371-0922
Practice Address - Street 1:12 CHATHAM HEIGHTS RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2566
Practice Address - Country:US
Practice Address - Phone:540-371-2777
Practice Address - Fax:540-371-0922
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010105351207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6303340Medicaid
VA180000634Medicare PIN
VA6303340Medicaid