Provider Demographics
NPI:1316527658
Name:GOLD PEDIATRICS, LLC
Entity type:Organization
Organization Name:GOLD PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-517-9710
Mailing Address - Street 1:15005 SHADY GROVE RD STE 450
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6377
Mailing Address - Country:US
Mailing Address - Phone:301-517-9710
Mailing Address - Fax:301-517-9713
Practice Address - Street 1:15005 SHADY GROVE RD STE 450
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6377
Practice Address - Country:US
Practice Address - Phone:301-517-9710
Practice Address - Fax:301-517-9713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD014465700Medicaid