Douglas Walsh, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

D0041304 Issued in MD

Practice address

4110 Medical Center Drive
Dermatology Associates
Fayetteville, NY 13066-2075

Phone

(706) 267-6239

NPI assigned

Jul 26, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

George Washington University School of Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr. Fazeli and Dr. Broumand LLCGroup PAC ID 0446358063, 11 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Fazeli & Dr. Broumand LLC

  • Dermatology Physician
  • Fayetteville, NY
  • NPI 1336235639
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1306860119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6154 SPRINGDALE CIR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132242075",
            "telephone_number": "706-267-6239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4110 MEDICAL CENTER DRIVE",
            "address_2": "DERMATOLOGY ASSOCIATES",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130662075",
            "telephone_number": "706-267-6239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MD",
            "license": "D0041304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M. Wade, L.C.S.W.
• Katey Waldon, NP
• Keith Paul Waldron, P.T.
• Walgreen Co
• Julie M Wallace, PT
• Hannah Joan Walsh, FNP-C
• Charles Brian Walton, LCSW
• Rui Wang
• Warby Parker Inc.
• Michael Nathen Warren, MPAS, PA-C

• Dermatology Physician in Fayetteville, NY
• Providers in Fayetteville, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.