Graduated: 2003
NPI: 1164584355
Practice Locations (2)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
1221 MERCANTILE LN
LARGO, MD 207745374
3016185700
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
2391 GREENSPRING DR
TIMONIUM, MD 210936038
3018162424
Source: CMS National Downloadable File, September 2026.