Organization
KIMBERLY S WALLACE MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA COYER (OFFICE MANAGER)
(410) 693-9648
Entity
Organization
Contact information
Practice address
1438 DEFENSE HWY STE 201, GAMBRILLS, MD 21054-2021
(410) 721-3200
(877) 922-4349
Mailing address
1438 DEFENSE HWY STE 201, GAMBRILLS, MD 21054-2021
(410) 721-3400
(877) 922-4349
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
04/01/2024
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