Individual
MRS. KELSEY BRIANNA SUPPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
301 HOSPITAL DR, GLEN BURNIE, MD 21061
(410) 787-4000
Mailing address
1306 OAK RD, SEVERNA PARK, MD 21146-3402
(410) 491-2212
Taxonomy
Speciality
Code
Description
License number
State
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
C0005671
MD
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/16/2015
Last updated
11/06/2023
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