Graduated: 2005
NPI: 1710229653
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
1396 PICCARD DR
ROCKVILLE, MD 208504302
3015485700
Source: CMS National Downloadable File, September 2026.