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General NPI Number Information
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NPI Number | 1043378656
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 07/24/2025
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Provider Practice Location Address
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Address Line | KAISER PERMANENTE-SOUTH BALTIMORE 1701 TWIN SPRINGS ROAD
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City | HALETHORPE
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State | MD
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Zip | 21227-3553
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Country | US
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Telephone | 410-737-5000
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Fax | 443-263-7381
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Provider Business Mailing Address
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Address Line | 4000 GARDEN CITY DRIVE 4TH FLOOR PPQA
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City | HYATTSVILLE
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State | MD
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Zip | 20785-2418
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Country | US
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Telephone | 301-816-2424
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Fax | 301-816-7170
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Authorized Official
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Title or Position | DIRECTOR,CREDENTIALING/PROVIDER ENR
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Name | COLLEEN E SWINTON
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Credential |
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Telephone | 301-257-2797
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133N00000X
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Taxonomy Name | Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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