Individual
MS. KRISTIN NICOLE SOMERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6701 N CHARLES ST, BALTIMORE, MD 21204-6808
(443) 849-2000
Mailing address
6535 N CHARLES ST STE 510, TOWSON, MD 21204-5832
(443) 849-2001
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
C0004260
MD
363AS0400X
Surgical Physician Assistant
Primary
C0004260
MD
Other
Enumeration date
08/27/2010
Last updated
06/16/2023
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