Provider Demographics
NPI:1750569802
Name:NELSON GUSTAVO NEDER KALIL, M.D.
Entity type:Organization
Organization Name:NELSON GUSTAVO NEDER KALIL, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:GUSTAVO NEDER
Authorized Official - Last Name:KALIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-467-5888
Mailing Address - Street 1:6000 EXECUTIVE BLVD STE 620
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3876
Mailing Address - Country:US
Mailing Address - Phone:240-467-5888
Mailing Address - Fax:301-348-8983
Practice Address - Street 1:6000 EXECUTIVE BLVD STE 620
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852
Practice Address - Country:US
Practice Address - Phone:240-467-5888
Practice Address - Fax:301-348-8983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051616207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD694501500Medicaid
MDH47172Medicare UPIN
MD694501500Medicaid