Individual provider Active NPI

Errol Keith Douglas, M.D.

  • Pediatrics Physician
  • Rockville, MD
National Provider Identifier
1962529875
Registry record updated May 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D0064791 Issued in MD
Practice address
15005 Shady Grove Rd Ste 130
Rockville, MD 20850-6341
Phone
(301) 517-9710
Fax
(301) 517-9713
NPI assigned
Mar 23, 2007
Last updated
May 9, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D0064791 MD Primary

Addresses

Primary practice location

15005 Shady Grove Rd Ste 130
Rockville, MD 20850-6341

Mailing address

15005 Shady Grove Rd Ste 450
Rockville, MD 20850-6377
Phone (301) 517-9710

Other identifiers 1

IdentifierTypeStateIssuer
013709000MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D0064791MDMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cedar Health Ventures, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: errol.douglas@gpl.eclinicaldirectplus.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/GCCFCD/Endpoint/GCCFCD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683590400000",
    "number": "1962529875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15005 SHADY GROVE RD STE 450",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506377",
            "telephone_number": "301-517-9710",
            "fax_number": "301-517-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15005 SHADY GROVE RD STE 130",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208506341",
            "telephone_number": "301-517-9710",
            "fax_number": "301-517-9713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "ERROL",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2023-05-09",
        "certification_date": "2023-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D0064791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "013709000",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.