Provider Demographics
NPI:1376562926
Name:BARTIMOCCIA, MICHELLE L (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:BARTIMOCCIA
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 1:2088 PRINCESS ANNE RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4014
Mailing Address - Country:US
Mailing Address - Phone:757-668-6700
Mailing Address - Fax:757-668-6680
Practice Address - Street 1:2088 PRINCESS ANNE RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4014
Practice Address - Country:US
Practice Address - Phone:757-668-6700
Practice Address - Fax:757-668-6680
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235698208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10037697Medicaid
102694OtherANTHEM BCBS,HK,HK,FAMIS
VA7868530OtherAETNA
NC541778786OtherNC HEALTH
VA5417787860687EOtherCIGNA
2119616OtherUHC,ALLIANCE,MDIPA,MAMSI
VA36474OtherOPTIMA, FAMCARE,FAMIS
VAH62909Medicare UPIN