Provider Demographics
NPI:1518915370
Name:FAULKENBERRY, BRADFORD K (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:K
Last Name:FAULKENBERRY
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 1:1707 BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-5543
Mailing Address - Country:US
Mailing Address - Phone:910-276-2439
Mailing Address - Fax:910-276-2404
Practice Address - Street 1:1707 BERWICK DR
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-5543
Practice Address - Country:US
Practice Address - Phone:910-276-2439
Practice Address - Fax:910-276-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32360207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8931376Medicaid
NC204132BMedicare PIN