Healthcare Provider Details

I. General information

NPI: 1689463838
Provider Name (Legal Business Name): MARYAM KIA MD, MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 WOODIS AVE
NORFOLK VA
23510-1026
US

IV. Provider business mailing address

714 WOODIS AVE
NORFOLK VA
23510-1026
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-5600
  • Fax:
Mailing address:
  • Phone: 714-446-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2084N0400X
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: