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General NPI Number Information
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NPI Number | 1629223250
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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 | 11/24/2008
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 1201 HOSPITAL DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8428
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Country | US
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Telephone | 540-368-3800
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Fax |
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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 | 301-257-2797
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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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 | 333600000X
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Taxonomy Name | Pharmacy
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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 | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number | 0201004261
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License Number State | VA
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