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NPI Code Detail

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

General Provider Information

NPI Number : 1750456695
Entity Type Code : Organization
Provider Name (Legal Business Name) : KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Provider Business Mailing Address
First Line : 4000 GARDEN CITY DR
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-2418
Country : US
Telephone Number : 301-816-2424
Fax Number :
Provider Business Practice Location Address
First Line : 6104 OLD BRANCH AVENUE
Second Line :
City : TEMPLE HILLS
State : MD
Zip : 20748-2518
Country : US
Telephone Number : 301-702-6172
Fax Number : 301-702-6117
Authorized Official
Title or Position : CREDENTIALING DIRECTOR
Name : COLLEEN SWINTON
Credential :
Telephone Number : 301-257-2797
Provider Enumeration Date : 11/22/2006
Last Update Date : 10/10/2025

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