Provider Demographics
NPI:1952349474
Name:FALTERMAN, MARY L (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:FALTERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7603 FOREST AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4942
Mailing Address - Country:US
Mailing Address - Phone:804-285-1611
Mailing Address - Fax:804-285-1615
Practice Address - Street 1:7603 FOREST AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4942
Practice Address - Country:US
Practice Address - Phone:804-285-1611
Practice Address - Fax:804-285-1615
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010447502080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006072461Medicaid
VA370000411Medicare ID - Type Unspecified
VA006072461Medicaid