Provider Demographics
NPI:1336225689
Name:FAULK, CHARLIE MICAH (MD)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:MICAH
Last Name:FAULK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD
Practice Address - Street 2:SUITE 480
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-5660
Practice Address - Fax:757-534-5687
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2016-01-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029830207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD82205Medicare UPIN
VA160000503Medicare ID - Type Unspecified
VAD82205Medicare UPIN