Provider Demographics
NPI:1831128750
Name:FIGARO, KELSON MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:KELSON
Middle Name:MICHAEL
Last Name:FIGARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 ANNAPOLIS ROAD, STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769
Mailing Address - Country:US
Mailing Address - Phone:301-464-3682
Mailing Address - Fax:301-464-3684
Practice Address - Street 1:12150 ANNAPOLIS ROAD, STE 200
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769
Practice Address - Country:US
Practice Address - Phone:301-464-3682
Practice Address - Fax:301-464-3684
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCJ443-0001OtherCAREFIRST BLUE SHEILD
DC034361200Medicaid
MDP00099569OtherRAIL ROAD MEDICARE
MDP00099569OtherRAIL ROAD MEDICARE
MDH10290Medicare UPIN