Individual
DR. KIMBERLY DESTEFANO LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4225 ALTAMONT PL STE 201, WHITE PLAINS, MD 20695-3065
(240) 607-1500
Mailing address
9910 FRANKLIN SQUARE DR STE 2110, BALTIMORE, MD 21236-4902
(410) 933-5412
(410) 535-6131
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D51722
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123200560
—
MD
01
—
5619003
BCBS FEDERAL
—
Enumeration date
05/04/2006
Last updated
05/21/2018
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