Provider Demographics
NPI:1912638529
Name:FAULKNER, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 GENESEE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3599
Mailing Address - Country:US
Mailing Address - Phone:315-253-8477
Mailing Address - Fax:315-253-4727
Practice Address - Street 1:144 GENESEE ST STE 201
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3529
Practice Address - Country:US
Practice Address - Phone:315-253-8477
Practice Address - Fax:315-515-3191
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008530RX363A00000X
NY031109363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant