Provider Demographics
NPI:1528064177
Name:G. REED FAILING, JR, MD,PA
Entity type:Organization
Organization Name:G. REED FAILING, JR, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:REED
Authorized Official - Last Name:FAILING
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-1051
Mailing Address - Street 1:PO BOX 1307
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-1307
Mailing Address - Country:US
Mailing Address - Phone:301-777-1051
Mailing Address - Fax:301-722-2475
Practice Address - Street 1:925 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1817
Practice Address - Country:US
Practice Address - Phone:301-777-1051
Practice Address - Fax:301-722-2475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0015631207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096655000OtherWEST VIRGINIA MEDICAID
MD979411500Medicaid
1109316OtherUMWA
D76635Medicare UPIN