Provider Demographics
NPI:1083645386
Name:FAUSER, DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:FAUSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 STONELEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3940
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE. SUITE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159805174400000X
CT29699174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00017644OtherRAILROAD MEDICARE
NY4682510001OtherMEDICARE
NY200045547OtherRAILROAD MEDICARE
NY522F61Medicare PIN
NY4682510001Medicare NSC
NY4682510004Medicare NSC
NY4682510003Medicare NSC