MEDICARE: KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1265971873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

Provider Business Mailing Address
First Line	:	4000 GARDEN CITY DR
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20785-2418
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 BOX HILL CORPORATE CENTER DR STE 100&200
Second Line	:
City	:	ABINGDON
State	:	MD
Zip	:	21009-1290
Country	:	US
Telephone Number	:	410-515-5440
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	COLLEEN SWINTON
Credential	:
Telephone Number	:	301-257-2797

Provider Enumeration Date	:	02/15/2017
Last Update Date	:	07/24/2025

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