Provider Demographics
NPI:1336153428
Name:FAULKENBERRY, WILLIAM L II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:FAULKENBERRY
Suffix:II
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 1:70 MEDICAL CENTER CIR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2273
Mailing Address - Country:US
Mailing Address - Phone:540-332-5999
Mailing Address - Fax:540-332-5990
Practice Address - Street 1:70 MEDICAL CENTER CIR
Practice Address - Street 2:SUITE 213
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2273
Practice Address - Country:US
Practice Address - Phone:540-332-5999
Practice Address - Fax:540-332-5990
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007330057Medicaid
VA068559OtherANTHEM
VA007330057Medicaid
B74686Medicare UPIN