Basic Information
| Provider Information | |||||||||
| NPI: | 1174582423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALTAOUS | ||||||||
| FirstName: | ADEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5185 US ROUTE 60 E | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918910 | ||||||||
| FaxNumber: | 3046911860 | ||||||||
| Practice Location | |||||||||
| Address1: | 5185 US ROUTE 60 E | ||||||||
| Address2: | SUITE 26 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257052078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918910 | ||||||||
| FaxNumber: | 3046911860 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2082S0105X | 17911 | WV | N | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 208200000X | 17911 | WV | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0984118 | 05 | OH | MEDICAID | 0114070000 | 05 | WV | MEDICAID | 64700362 | 05 | KY | MEDICAID |