Provider Demographics
NPI:1457416000
Name:KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Entity type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:SWINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-257-2729
Mailing Address - Street 1:4000 GARDEN CITY DR
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2418
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:703-466-4802
Practice Address - Street 1:1890 METRO CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5276
Practice Address - Country:US
Practice Address - Phone:703-709-1810
Practice Address - Fax:703-709-1688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-26
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy