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General NPI Number Information
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NPI Number | 1043438740
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE MID-ATLANTIC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 6501 LOISDALE CT
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1826
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Country | US
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Telephone | 703-922-1034
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 GOOD LION CT
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City | ALEXANDRIA
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State | VA
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Zip | 22315-4623
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Country | US
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Telephone | 703-922-1034
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Fax | 703-922-1628
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. ELEANOR ANNE WILSON
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Credential | DPM
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Telephone | 703-922-1034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0103000949
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License Number State | VA
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