MEDICARE: DR. ERROL KEITH DOUGLAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	D0064791	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962529875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERROL KEITH DOUGLAS M.D.

Provider Business Mailing Address
First Line	:	15005 SHADY GROVE RD STE 450
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6377
Country	:	US
Telephone Number	:	301-517-9710
Fax Number	:	301-517-9713

Provider Business Practice Location Address
First Line	:	15005 SHADY GROVE RD STE 130
Second Line	:
City	:	ROCKVILLE
State	:	MD
Zip	:	20850-6341
Country	:	US
Telephone Number	:	301-517-9710
Fax Number	:	301-517-9713

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	05/09/2023

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