| Kimberly S Wallace Md Llc | |
|
1438 Defense Hwy Ste 201 Gambrills MD 21054-2021 | |
| (410) 721-3200 | |
| (877) 922-4349 |
| Full Name | Kimberly S Wallace Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1438 Defense Hwy Ste 201, Gambrills, Maryland |
| Authorized Official Name and Position | Lisa Coyer (OFFICE MANAGER) |
| Authorized Official Contact | 4106939648 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly S Wallace Md Llc 1438 Defense Hwy Ste 201 Gambrills MD 21054-2021 Ph: (410) 721-3400 | Kimberly S Wallace Md Llc 1438 Defense Hwy Ste 201 Gambrills MD 21054-2021 Ph: (410) 721-3200 |
| NPI Number | 1790537132 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 04/01/2024 |
| Medicare PECOS PAC ID | 8426499294 |
|---|---|
| Medicare Enrollment ID | O20240510000306 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790537132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kimberly S Wallace |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770627705 PECOS PAC ID: 5496937351 Enrollment ID: I20130115000239 |
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