# KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477618502
- **Authorized official:** COLLEEN SWINTON (CREDENTIALING DIRECTOR)
- **Authorized official phone:** (301) 257-2729

## Contact information

- **Practice address:** 7190 CRESTWOOD BLVD, FREDERICK, MD 21703
- **Practice address phone:** (240) 529-1800
- **Mailing address:** 4000 GARDEN CITY DR, HYATTSVILLE, MD 20785-2418
- **Mailing address phone:** (301) 816-2424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336M0003X | Managed Care Organization Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/27/2006
- **Last updated:** 07/24/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2133229 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |