Healthcare Provider Details

I. General information

NPI: 1932527835
Provider Name (Legal Business Name): MATTHEW WALSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S ANDREWS AVE
FORT LAUDERDALE FL
33316-2510
US

IV. Provider business mailing address

1611 NW 12TH AVE WEST WING 279
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 954-355-5500
  • Fax:
Mailing address:
  • Phone: 305-585-7878
  • Fax: 305-585-5743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME144313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: