Graduated: 1991
NPI: 1811239825
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
1890 METRO CTR DR
RESTON, VA 201905286
7037091500
Source: CMS National Downloadable File, September 2026.