Provider Demographics
NPI:1649348897
Name:FAULKNER, ANDREA (MD)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 LIME ROCK LN
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3122
Mailing Address - Country:US
Mailing Address - Phone:585-381-5393
Mailing Address - Fax:
Practice Address - Street 1:10 OFFICE PARK WAY
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-1765
Practice Address - Country:US
Practice Address - Phone:585-586-9640
Practice Address - Fax:585-586-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1827422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01482686Medicaid
NYF74569Medicare UPIN