Provider Demographics
NPI:1376789859
Name:WEISS, KIMBERLY SUE (PA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:WEISS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4801 DORSEY HALL DR STE 201
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7749
Mailing Address - Country:US
Mailing Address - Phone:410-997-4780
Mailing Address - Fax:410-997-3196
Practice Address - Street 1:6355 TEN OAKS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1185
Practice Address - Country:US
Practice Address - Phone:410-531-1440
Practice Address - Fax:410-531-1412
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2021-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC0001240363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical