Provider Demographics
NPI:1902908528
Name:FAULKNER, JUDITH X (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:X
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 NEW HAVEN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460
Mailing Address - Country:US
Mailing Address - Phone:203-877-5634
Mailing Address - Fax:203-876-1840
Practice Address - Street 1:1 NEW HAVEN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460
Practice Address - Country:US
Practice Address - Phone:203-877-5634
Practice Address - Fax:203-876-1840
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT027577207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT33082Medicare UPIN