Individual
KIMBERLY MARY SPAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
825 FAIRFAX AVE, SUITE 445, NORFOLK, VA 23507-1914
(757) 446-8920
(757) 446-5242
Mailing address
1060 FIRST COLONIAL RD, VIRGINIA BEACH, VA 23454-3002
(757) 395-2323
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101246307
VA
208M00000X
Hospitalist Physician
0101246307
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-028
TRICARE/CHAMPUS
VA
01
—
10071693
SENTARA/OPTIMA HEALTH
VA
01
—
1336302454
FIRST HEALTH NETWORK/COVENTRY HEALTH
VA
05
—
1336302454
—
VA
01
—
422982
ANTHEM BC/BS
VA
05
—
5916953
—
NC
01
—
PAR
VIRGINIA HEALTH NETWORK
VA
Enumeration date
07/09/2008
Last updated
10/30/2024
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