Individual provider Active NPI

Edward John Coll, M.D.

  • Developmental - Behavioral Pediatrics Physician
  • Rockville, MD
National Provider Identifier
1952354110
Registry record updated Sep 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental - Behavioral Pediatrics PhysicianTaxonomy code 2080P0006X
License
D76446 Issued in MD
Practice address
1396 Piccard Dr
Kaiser Permanente Shady Grove Medical Center
Rockville, MD 20850-4302
Phone
(301) 548-5700
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental - Behavioral Pediatrics Physician 2080P0006X MD041142E PA
Developmental - Behavioral Pediatrics Physician 2080P0006X D76446 MD Primary

Addresses

Primary practice location

1396 Piccard Dr
Kaiser Permanente Shady Grove Medical Center
Rockville, MD 20850-4302

Mailing address

2101 E Jefferson St
Kaiser Permanente Medicare Enrollment
Rockville, MD 20852-4908
Phone (301) 816-2424

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC
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

Enrollment IDStateProvider typePAC IDDetails
I20131118000603 DC Practitioner - Pediatric Medicine 3577799758 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
D76446MDMDDevelopmental - Behavioral Pediatrics Physician
MD041142EPAMDDevelopmental - Behavioral Pediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 10, 2013 Accepting new patients
Kaiser Foundation Health Plan of the Mid Atlantic States, Inc CurrentSince Sep 10, 2013 Accepting new patients
Major Hospital Past Accepting new patients

Locations

1396 Piccard Dr
Rockville, MD 20850
Phone (301) 548-5700

2101 E Jefferson St
Ste 6
Rockville, MD 20852

2101 E Jefferson St
Rockville, MD 20852
Phone (301) 816-6660

1221 Mercantile Ln
Upper Marlboro, MD 20774
Phone (301) 618-5500

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1952354110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2101 E JEFFERSON ST",
            "address_2": "KAISER PERMANENTE MEDICARE ENROLLMENT",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208524908",
            "telephone_number": "301-816-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1396 PICCARD DR",
            "address_2": "KAISER PERMANENTE SHADY GROVE MEDICAL CENTER",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208504302",
            "telephone_number": "301-548-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLL",
        "first_name": "EDWARD",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "PA",
            "license": "MD041142E",
            "primary": false
        },
        {
            "code": "2080P0006X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Developmental - Behavioral Pediatrics",
            "state": "MD",
            "license": "D76446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

Verify at the official NPI Registry.