Provider Demographics
NPI:1477934768
Name:WEIR, KIMBERLY ALISON (LAC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ALISON
Last Name:WEIR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:ALISON
Other - Last Name:QUINLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:703 GIDDINGS AVE
Mailing Address - Street 2:SUITE L5
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1411
Mailing Address - Country:US
Mailing Address - Phone:410-263-2228
Mailing Address - Fax:240-713-3228
Practice Address - Street 1:703 GIDDINGS AVE
Practice Address - Street 2:SUITE L5
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1411
Practice Address - Country:US
Practice Address - Phone:410-263-2228
Practice Address - Fax:240-713-3228
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02233171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist