DR. BRENT CABELL FAULKNER, MD - NPI NUMBER 1912999657

Summary

Provider Name: DR. BRENT CABELL FAULKNER, MD

NPI Number: 1912999657

Clasification: Plastic Surgery (208200000X)

Organization: AMBULATORY PLASTIC SURGERY CENTER ASSOCIATES, CHARTERED

Address:
15245 SHADY GROVE RD
SUITE 155
ROCKVILLE, MD
ZIP 20850

Phone Number: (240) 912-4708



Detailed Information

DR. Brent Cabell Faulkner, MD is a plastic surgeon in Rockville, MD with 16 years of experience. The provider is a plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk and external genitalia or cosmetic enhancement of these areas of the body. Cosmetic surgery is an essential component of plastic surgery. The plastic surgeon uses cosmetic surgical principles to both improve overall appearance and to optimize the outcome of reconstructive procedures. The surgeon uses aesthetic surgical principles not only to improve undesirable qualities of normal structures but in all reconstructive procedures as well. The assigned NPI number for this provider is 1912999657 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: MEDICAL COLLEGE OF VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1999

The provider's business address is:

15245 SHADY GROVE RD
SUITE 155
ROCKVILLE, MD
ZIP 20850-222
Phone: (240) 912-4708
Fax: (240) 912-6992

The enumeration date for this NPI number is 8/18/2005 and was last updated on 4/9/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208200000X Plastic Surgery D0063076 MD Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 017815A44 OTHER MD MEDICARE ID
2 I39789 MEDICARE UPIN MD

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1912999657 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 1 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Provider Last Name Legal Name FAULKNER The last name of the provider. If the provider is an individual, this is the legal name.
4 Provider First Name BRENT The first name of the provider, if the provider is an individual.
5 Provider Middle Name CABELL The middle name of the provider, if the provider is an individual.
6 Provider Name Prefix Text DR. The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
7 Provider Credential Text MD The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
8 Provider First Line Business Practice Location Address 15245 SHADY GROVE RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Second Line Business Practice Location Address SUITE 155 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
10 Provider Business Practice Location Address City Name ROCKVILLE The city name in the location address of the provider being identified.
11 Provider Business Practice Location Address State Name MD The State code in the location of the provider being identified.
12 Provider Business Practice Location Address Postal Code 208503222 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
13 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
14 Provider Business Practice Location Address Telephone Number 2409124708 The telephone number associated with the location address of the provider being identified.
15 Provider Business Practice Location Address Fax Number 2409126992 The fax number associated with the location address of the provider being identified.
16 Provider Enumeration Date 8/18/2005 The date the provider was assigned a unique identifier (assigned an NPI).
17 Last Update Date 4/9/2014 The date that a record was last updated or changed.
18 Provider Gender Code M The code designating the provider’s gender if the provider is a person.
19 Healthcare Provider Taxonomy Code 1 208200000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 D0063076 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 MD The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Other Provider Identifier 1 017815A44 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 1 MD
26 Other Provider Identifier Issuer 1 MEDICARE ID
27 Other Provider Identifier 2 I39789 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 MD
30 Is Sole Proprietor N Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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