Individual provider · NPI-1

Kelsey Brianna Suppa, PA-C

Physician Assistant · Glen Burnie, MD

NPI number1053700815
StatusActive
Last updated in NPPESNov 6, 2023

Details

NPI
1053700815
Entity type
Individual (NPI-1)
Name
Mrs. Kelsey Brianna Suppa
Credential
PA-C
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 16, 2015
Last updated
Nov 6, 2023

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant––Yes
2082S0105X Plastic Surgery, Surgery of the HandC0005671MD

Other names

  • Kelsey Brianna Suppa (Former Name)

Practice location

301 Hospital Dr
Glen Burnie, MD 21061

Phone 410-787-4000

Mailing address

1306 Oak Rd
Severna Park, MD 21146-3402

Phone 410-491-2212

Other practice locations

4940 Eastern Ave
Baltimore, MD 21224-2735

Phone 410-491-2212

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