Provider Demographics
NPI:1821156449
Name:FALTUS, FRANK JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:JOHN
Last Name:FALTUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROV
Mailing Address - State:RI
Mailing Address - Zip Code:02906
Mailing Address - Country:US
Mailing Address - Phone:401-421-0060
Mailing Address - Fax:401-421-6676
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906
Practice Address - Country:US
Practice Address - Phone:401-421-0060
Practice Address - Fax:401-421-6676
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD47132084P0800X
RIRI47132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIA68274Medicare UPIN