Individual
WANDA J SIMMONS CLEMMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6724 GLENKIRK RD, BALTIMORE, MD 21239-1410
(443) 900-3184
(410) 433-2015
Mailing address
808 GLENEAGLES CT # 20069, TOWSON, MD 21286-2205
(443) 900-3184
(512) 559-7040
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
D0035674
MD
207QG0300X
Geriatric Medicine (Family Medicine) Physician
D0035674
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
535071900
—
MD
01
—
D0035674
MEDICAL LICENSE
MD
Enumeration date
10/20/2006
Last updated
01/02/2025
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