Basic Information
| Provider Information | |||||||||
| NPI: | 1700914025 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KAISER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 AMELIA ISLAND CT | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209054123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014769299 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 FOREST GLENN RD | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017547126 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | DOWNARD | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DOP | ||||||||
| AuthorizedOfficialTelephone: | 3018162424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RPH | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 15200 | MD | Y | Hospitals | General Acute Care Hospital | Critical Access |
No ID Information.