Provider Demographics
NPI:1265422570
Name:DEFIGLIO-SMITH, ANN MARIE (MD)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:DEFIGLIO-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANN MARIE
Other - Middle Name:D
Other - Last Name:CAMPOLATTARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:307 COOK RD
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23690-9640
Practice Address - Country:US
Practice Address - Phone:757-898-7261
Practice Address - Fax:757-890-0139
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010094585Medicaid
VAP00174021OtherRAILROAD MEDICARE
VAP00174021OtherRAILROAD MEDICARE
VAH59022Medicare UPIN