Individual
KIMBERLY SHANNON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1438 DEFENSE HWY SUITE 201, GAMBRILLS, MD 21054
(410) 721-3200
(410) 721-2680
Mailing address
1438 DEFENSE HWY SUITE 201, GAMBRILLS, MD 21054
(410) 721-3200
(410) 721-2680
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
D66924
MD
Other
Enumeration date
02/15/2007
Last updated
03/18/2019
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