Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kimberly Shannon Wallace, MD

Individual provider Family Medicine Physician · NPI 1770627705

Kimberly Shannon Wallace, MD is a Family Practice in Gambrills, Maryland. Graduated from University of Maryland School of Medicine in 2004, 22 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Maryland.

Years since qualifying
22
Trained at
University of Maryland School of Medicine
Licensed in
MD
In the registry since
2007
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1438 Defense Hwy Ste 201
Gambrills, MD 21054
Phone: (410) 721-3200
Fax: (410) 721-2680
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence D66924 (MD)

Record details

NPI number1770627705
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorYes
NPI enumeratedFebruary 15, 2007
Last updated in NPPESMarch 18, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF MARYLAND SCHOOL OF MEDICINE
Graduated 2004 (22 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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