Individual
MICHAEL WELLINGTON FAULK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2 CRESCENT PARK WEST, WARREN, PA 16365-2111
(814) 723-2510
(814) 723-4654
Mailing address
2 CRESCENT PARK WEST, WARREN, PA 16365-2111
(814) 723-2510
(814) 723-4654
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD432033
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000543098
ANTHEM
OH
05
—
1019333580004
—
PA
05
—
2770014
—
OH
01
—
N424355
NON PAR WELLCARE
OH
Enumeration date
05/14/2007
Last updated
05/21/2013
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