Provider Demographics
NPI:1669473260
Name:KINGSBURY, MICHELLE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:KINGSBURY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHELLE
Other - Middle Name:KINGSBURY
Other - Last Name:RESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:#103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-460-2171
Practice Address - Fax:757-460-3708
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047049207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCORVEL (EVMS HEALTH SERVICES)
VA1669473260OtherCOVENTRY HEALTH/SOUTHERN HEALTH NETWORKS
VA-003OtherCHAMPUS (EVMS HEALTH SERVICES)
VA1669473260Medicaid
VA447041OtherANTHEM BC/BS (PORTSMOUTH FAMILY MEDICINE)
VA5645697Medicaid
NC89066F3Medicaid
VAPAROtherAETNA (EVMS HEALTH SERVICES)
VA5645697Medicaid
019228B28Medicare PIN