Basic Information
| Provider Information | |||||||||
| NPI: | 1447256052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FALARDEAU | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1022 LEE ANN DR NE | ||||||||
| Address2: | |||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048861918 | ||||||||
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| Practice Location | |||||||||
| Address1: | 367 S ANDY GRIFFITH PKWY | ||||||||
| Address2: | STE 200 | ||||||||
| City: | MOUNT AIRY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270304010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3364439190 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2005 | ||||||||
| LastUpdateDate: | 10/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | 263 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine | 213ES0103X | 263 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0131X | 263 | NC | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | 263 | NC | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 890807G | 05 | NC | MEDICAID |