Manuel J Datiles IV, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

D0079527 Issued in MD

Practice address

5963 Exchange Dr Ste 100
Eldersburg, MD 21784-9256

Phone

(410) 549-0900

Fax

(410) 549-6121

NPI assigned

Apr 16, 2012

Last updated

Jan 6, 2021By the provider in NPPES

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 DE, MD2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: manuel.datiles.1@8042.direct.athenahealth.com

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

• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  MD, Pediatrics

  Medicare reassignment NPD
• The Nemours Foundation

  • Multi-Specialty Clinic/Center
  • Wilmington, DE
  • NPI 1366594699
  Medicare reassignment NPD
• Privia Medical Group, LLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Rockville, MD
  • NPI 1811715436
  NPD
• The Nemours Foundation

  • Children's Hospital
  • Wilmington, DE
  • NPI 1467505073
  NPD
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)
• Liberty Pediatrics and Family Medicine LLC

  • Pediatrics Physician
  • Sykesville, MD
  • NPI 1457311094
  NPD (past)
• Medical Associates of Central Virginia, Inc.

  • Internal Medicine Physician
  • Lynchburg, VA
  • NPI 1912970260
  NPD (past)

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

{
    "created_epoch": "1334534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609891200000",
    "number": "1043577000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5963 EXCHANGE DR STE 100",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217849256",
            "telephone_number": "410-549-0900",
            "fax_number": "410-549-6121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5963 EXCHANGE DR STE 100",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217849256",
            "telephone_number": "410-549-0900",
            "fax_number": "410-549-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATILES",
        "first_name": "MANUEL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-16",
        "last_updated": "2021-01-06",
        "certification_date": "2021-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0079527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyell Crary
• CRH MD Management LLC (Patriot Urgent Care)
• Janel Renee Cubbage, LCPC
• Daljaco (Visiting Angels)
• Ashna Dalwadi
• Courtney B Davis, LCPC
• Kerri Leigh Davis, CRNP
• Michael I. Davis, O.D.
• Ronald Davis, D.D.S.
• Sally R Davis, DDS

• Pediatrics Physician in Eldersburg, MD
• Providers in Eldersburg, MD by specialty
• Pediatrics Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.