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General NPI Number Information
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NPI Number | 1568520070
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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 | 12011 LEE JACKSON HIGHWAY
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City | FAIRFAX
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State | VA
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Zip | 22033-3310
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Country | US
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Telephone | 703-257-3050
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Fax | 703-257-3042
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Provider Business Mailing Address
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Address Line | 4000 GARDEN CITY DR
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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 | CREDENTIALING DIRECTOR
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Name | MRS. 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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number |
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License Number State |
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