# MID-ATLANTIC FAMILY PRACTICE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477766020
- **Authorized official:** DR. MICHELLE ELIZABETH KINGSBURY MD (OWNER)
- **Authorized official phone:** (757) 460-2171

## Contact information

- **Practice address:** 1020 INDEPENDENCE BLVD, \#103, VIRGINIA BEACH, VA 23455-5500
- **Practice address phone:** (757) 460-2171
- **Mailing address:** 1020 INDEPENDENCE BLVD, \#103, VIRGINIA BEACH, VA 23455-5500
- **Mailing address phone:** (757) 460-2171

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 0101047049 | VA | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 05/14/2008

## 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 |