=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740340983
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAISER PERMANENTE ASHBURN MED CTR
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2006
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43480 YUKON DR STE 100
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-6984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-227-5006
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4000 GARDEN CITY DR
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-2418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-816-2424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING DIRECTOR
-----------------------------------------------------
Name | COLLEEN SWINTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-257-2797
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336M0003X
-----------------------------------------------------
Taxonomy Name | Managed Care Organization Pharmacy
-----------------------------------------------------
License Number | 0201004121
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------