Healthcare Provider Details

I. General information

NPI: 1669473260
Provider Name (Legal Business Name): MICHELLE ELIZABETH KINGSBURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE KINGSBURY RESSLER MD

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 INDEPENDENCE BLVD #103
VIRGINIA BEACH VA
23455-5500
US

IV. Provider business mailing address

3241 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5260
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-2171
  • Fax: 757-460-3708
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101047049
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: