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General NPI Number Information
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NPI Number | 1881406536
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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 | 01/21/2025
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Last Update Date | 10/10/2025
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Provider Practice Location Address
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Address Line | 10810 CONNECTICUT AVE
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City | KENSINGTON
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State | MD
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Zip | 20895-2138
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Country | US
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Telephone | 301-816-2424
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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 | 301-816-2424
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, CREDENTIALING
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Name | COLLEEN 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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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