KIMBERLY SHANNON WALLACE (NPI# 1770627705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770627705 |
| Entity Type | Individual |
| Full Name | KIMBERLY SHANNON WALLACE |
| Credential | MD |
| Practice Address |
1438 Defense Hwy Suite 201 Gambrills MD 21054 |
| Practice Telephone | 4107213200 |
| Practice Fax Number | 4107212680 |
| Mailing Telephone | 4107213200 |
| Mailing Fax Number | 4107212680 |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2019-03-18 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | D66924 | MD | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033457791 | Kimberly Wallace | Physical Therapist | 421 W School House Ln Unit 2, Philadelphia, PA 19144-4557 | 2013-01-30 |
| 1942592340 | Kimberly Wallace | Counselor | 1427 Se 182nd Ave, Portland, OR 97233-5008 | 2011-05-04 |
| 1669794137 | Kimberly Wallace | Registered Nurse | 214 Rosewood Ter, Cheektowaga, NY 14225-3016 | 2010-02-24 |
| 1144881640 | Kimberly Veronica Wallace | Advanced Practice Midwife | 100 Lillian Gish Blvd Sw Ste 201, Massillon, OH 44647-6500 | 2019-06-25 |
| 1316413271 | Kimberly Pauline Wallace | Pharmacist | 951 Central St, Franklin, NH 03235-2028 | 2018-10-18 |
| 1942705223 | Kimberly Wallace | Technician | 1312 S 8th St, Las Vegas, NV 89104-1638 | 2018-03-28 |
| 1043713936 | Kimberly Louise Wallace | Registered Nurse | 2040 Babcock Rd Ste 304, San Antonio, TX 78229-4428 | 2018-03-16 |
| 1265969133 | Kimberly Wallace | Registered Nurse | 3400 Bainbridge Ave, Bronx, NY 10467-2404 | 2017-05-22 |
| 1083091987 | Kimberly Wallace | Counselor | 1944 Brannan Rd, Mcdonough, GA 30253-4310 | 2015-04-29 |
| 1750785622 | Kimberly Wallace | Licensed Practical Nurse | 138 North Court Street, Wampsville, NY 13163 | 2014-10-21 |
| Street Address |
1438 DEFENSE HWY SUITE 201 |
| City | GAMBRILLS |
| State | MD |
| Zip Code | 21054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306447925 | Maksim Simakhodskiy | Massage Therapist | 1328 Waugh Chapel Way, Gambrills, MD 21054 | 2020-11-02 |
| 1013515154 | Ls Creative Agency LLC | Durable Medical Equipment & Medical Supplies | 1153 Route 3 North, Suite 10, Gambrills, MD 21054 | 2020-10-12 |
| 1710510540 | Mijeong Joo-bunyard | Physical Therapist | 1153 Md-3n, Suite 35, Gambrills, MD 21054 | 2020-02-20 |
| 1144873043 | Sadia Cheema | Nurse Practitioner | 1071 Md-3 North, Suite 101, Gambrills, MD 21054 | 2019-07-19 |
| 1235699620 | Sara Fiore Schwartz | Nurse Practitioner | 1071 Md-3 Suite 101, Gambrills, MD 21054 | 2019-03-21 |
| 1447759246 | Anne Arundel Physician Group, LLC | Obstetrics & Gynecology | 2401 Brandermill Boulevard Suite 350, Gambrills, MD 21054 | 2018-02-07 |
| 1821546391 | Aamg Physical Therapy, LLC | Speech-Language Pathologist | 1153 Route 3 N, Suite 35, Gambrills, MD 21054 | 2016-09-14 |
| 1780039818 | Drs Ergent Care, LLC | Clinic/Center | 1071 Route 3 N, Gambrills, MD 21054 | 2016-04-26 |
| 1871851212 | Sarsha Blackman | Dentist | 1166 Route 3 South, Suite 211, Gambrills, MD 21054 | 2012-04-23 |
| 1134485535 | Visionworks, Inc. | Eyewear Supplier (Equipment, not the service) | 1402 S. Main Chapel Way, Suite 114, Gambrills, MD 21054 | 2012-04-10 |
| Find all providers in zip 21054 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619924263 | Tara Thurlby Muscovich | Family Medicine | 1438 Defense Highway, Suite 201, Gambrills, MD 21054 | 2006-05-28 |
| 1508866336 | David Conrad Anderson | Family Medicine | 2401 Brandermill Blvd, Suite 360, Gambrills, MD 21054-1690 | 2005-07-22 |
| 1497076814 | Michelle Marie Skinner | Family Medicine | 2401 Brandermill Blvd, Gambrills, MD 21054-1690 | 2010-06-21 |
| 1548418825 | David Afzal | Family Medicine | 2401 Brandermill Blvd, Suite 250, Gambrills, MD 21054-1690 | 2008-08-29 |
| 1164450920 | Howard Kenneth Schultz Jr. | Family Medicine | 1438 Defense Highway, Suite 201, Gambrills, MD 21054 | 2006-06-29 |
| 1184664146 | Peter Su | Family Medicine | 1438 Defense Highway, Suite 201, Gambrills, MD 21054 | 2006-06-07 |
| 1982671103 | Anne Arundel Physician Group, LLC | Family Medicine | 2401 Brandermill Blvd, Suite 250, Gambrills, MD 21054-1690 | 2006-03-07 |
| 1497748800 | David G Freas | Family Medicine | 2401 Brandermill Blvd, Suite 250, Gambrills, MD 21054-1690 | 2005-08-31 |
| 1083607410 | Ian M Shantz | Family Medicine | 2401 Brandermill Blvd, Suite 250, Gambrills, MD 21054-1690 | 2005-08-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699375378 | Coastal Wellness Recovery | Family Medicine | 820 E Main St Unit 3, Salisbury, MD 21804-5025 | 2020-10-30 |
| 1770182693 | Britni Morgan | Family Medicine | 13620 Crayton Blvd Ste B, Hagerstown, MD 21742-2335 | 2020-10-21 |
| 1437757267 | Janice C Vaz | Family Medicine | 13912 Natia Manor Dr, North Potomac, MD 20878-4859 | 2020-10-14 |
| 1053918847 | Katherine Susan Dennis | Family Medicine | 1322 Belmont Ave Ste 201, Salisbury, MD 21804-4593 | 2020-10-05 |
| 1740893650 | Melissa Josanne Richards | Family Medicine | 4511 Old Court Rd, Pikesville, MD 21208-2428 | 2020-08-29 |
| 1861003121 | Mind Algn LLC | Family Medicine | 7920 Norfolk Ave Ste 290, Bethesda, MD 20814-2500 | 2020-08-11 |
| 1669095402 | Refresh Pain and Wellness, LLC | Family Medicine | 6314 Windsor Mill Rd Ste 100, Gwynn Oak, MD 21207-6078 | 2020-05-27 |
| 1386265015 | Judi De'landa Brown-brown | Family Medicine | 7522 Gilley Ter, Rosedale, MD 21237-3703 | 2020-05-05 |
| 1073142147 | Lakeside Med, LLC | Family Medicine | 7820b Wormans Mill Rd # 276, Frederick, MD 21701-3034 | 2020-04-02 |
| 1225662828 | Federal Hill Medical Center | Family Medicine | 724 A Light Street, Baltimore, MD 21230-3850 | 2020-02-24 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.