Provider Demographics
NPI:1396708665
Name:SMITH GRIFFIN, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:SMITH GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1300 SENTARA PARK # 3
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5884
Mailing Address - Country:US
Mailing Address - Phone:757-252-3050
Mailing Address - Fax:757-222-3106
Practice Address - Street 1:1300 SENTARA PARK # 3
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5884
Practice Address - Country:US
Practice Address - Phone:757-252-3050
Practice Address - Fax:757-222-3106
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058374207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080169571OtherRAILROAD MEDICARE
VA5853826Medicaid
NC89064J5Medicaid
NC89064J5Medicaid
VA080169571OtherRAILROAD MEDICARE