{
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"OrgName": "KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC",
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"FirstLineMailingAddress": "4000 GARDEN CITY DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HYATTSVILLE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "20785-2418",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "301-816-2424",
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"FirstLinePracticeLocationAddress": "655 WATKINS MILL RD",
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"PracticeLocationAddressCityName": "GAITHERSBURG",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressTelephoneNumber": "240-632-4150",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/09/2013",
"LastUpdateDate": "07/24/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SWINTON",
"AuthorizedOfficialFirstName": "COLLEEN",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "301-257-2797",
"Taxonomies": {
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"TaxonomyName": "Clinic/Center",
"LicenseNumber": "21762",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}