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Organization
MID-ATLANTIC FAMILY PRACTICE
Active
Organization
MID-ATLANTIC FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE ELIZABETH KINGSBURY MD (OWNER)
(757) 460-2171
Entity
Organization
Contact information
Practice address
1020 INDEPENDENCE BLVD, #103, VIRGINIA BEACH, VA 23455-5500
(757) 460-2171
Mailing address
1020 INDEPENDENCE BLVD, #103, VIRGINIA BEACH, VA 23455-5500
(757) 460-2171
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
0101047049
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005645697
—
VA
01
—
1669473260
PROVIDER NPI
VA
01
—
292836
ANTHEM BCBS
VA
01
—
2944020
AETNA/US HEALTHCARE
VA
01
—
298394
MAMSI
VA
01
—
60522
OPTIMA
—
01
—
CK8605
MEDICARE RAILROAD
VA
Enumeration date
05/08/2007
Last updated
05/14/2008
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