Provider Demographics
NPI:1437105665
Name:FAULKNER, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FAULKNER
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 1:3730 TABS DR
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-9562
Mailing Address - Country:US
Mailing Address - Phone:330-563-0603
Mailing Address - Fax:330-563-0604
Practice Address - Street 1:525 E MARKET ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1619
Practice Address - Country:US
Practice Address - Phone:330-375-3369
Practice Address - Fax:330-375-3769
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040837F207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000138500OtherANTHEM
OH341779226002OtherMEDICAL MUTUAL OH 1 OF 2
OH341779226003OtherMED MUTUAL OH 2 OF 2
OH0447412Medicaid
OH930023431OtherRR MEDICARE
OH340714755CCOtherSUMMACARE
OH61641OtherUNITED HEALTHCARE
OH0447412Medicaid
OHE78200Medicare UPIN
OH0772962Medicare ID - Type Unspecified2 OF 2