Healthcare Provider Details

I. General information

NPI: 1124333646
Provider Name (Legal Business Name): MICHELLE ANNA KIRSHENBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

4505 COLUMBUS ST STE 250
VIRGINIA BEACH VA
23462-5011
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7293
  • Fax:
Mailing address:
  • Phone: 757-499-7442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101253830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: