Provider Demographics
NPI:1548383086
Name:PALETSKY, FAULLIN (MD)
Entity Type:Individual
Prefix:
First Name:FAULLIN
Middle Name:
Last Name:PALETSKY
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 1:429 SALK CIR
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4667
Mailing Address - Country:US
Mailing Address - Phone:202-904-0431
Mailing Address - Fax:
Practice Address - Street 1:9901 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3357
Practice Address - Country:US
Practice Address - Phone:240-826-7578
Practice Address - Fax:240-826-5107
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92326207R00000X, 208M00000X
MDD0077416207R00000X
ORMD28142207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI28872Medicare UPIN