# KIMBERLY S WALLACE MD LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790537132
- **Authorized official:** LISA COYER (OFFICE MANAGER)
- **Authorized official phone:** (410) 693-9648

## Contact information

- **Practice address:** 1438 DEFENSE HWY STE 201, GAMBRILLS, MD 21054-2021
- **Practice address phone:** (410) 721-3200
- **Practice address fax:** (877) 922-4349
- **Mailing address:** 1438 DEFENSE HWY STE 201, GAMBRILLS, MD 21054-2021
- **Mailing address phone:** (410) 721-3400
- **Mailing address fax:** (877) 922-4349

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/01/2024
- **Last updated:** 04/01/2024