Provider Demographics
NPI:1336302454
Name:SPAN, KIMBERLY M (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:SPAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-2323
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246307208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherVIRGINIA PREMIER HEALTH PLAN
VAPAROtherAETNA
VA-028OtherTRICARE/CHAMPUS
VA1336302454OtherFIRST HEALTH NETWORK/COVENTRY HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherMULTIPLAN
VA10071693OtherSENTARA/OPTIMA HEALTH
VA1336302454Medicaid
VA422982OtherANTHEM BC/BS
VAPAROtherCORVEL/CORCARE
VAPAROtherUNITED HEALTHCARE
NC5916953Medicaid
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherCIGNA
VA422982OtherANTHEM BC/BS