Graduated: 2013
NPI: 1861909061
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
6551 LOISDALE CT
SPRINGFIELD, VA 221501828
7039221000
Source: CMS National Downloadable File, September 2026.