Provider Demographics
NPI:1962529875
Name:DOUGLAS, ERROL KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:ERROL
Middle Name:KEITH
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
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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 130
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6341
Practice Address - Country:US
Practice Address - Phone:301-517-9710
Practice Address - Fax:301-517-9713
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-05-09
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Provider Licenses
StateLicense IDTaxonomies
MDD0064791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD013709000Medicaid