| Organization Name: | KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC. |
| NPI Number: | 1407157597 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LARA E CROZIER (DELEGATED OFFICIAL) |
| Mailing Address: | 6104 Old Branch Ave Temple Hills |
| State: | MD US |
| Postal Code: | 207482518 |
| Phone Number: | 3017026109 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 11/09/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | R094722 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |