Healthcare Provider Details

I. General information

NPI: 1245280114
Provider Name (Legal Business Name): ANA MARIE DIZON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 FIRST COLONIAL RD SUITE 200
VIRGINIA BEACH VA
23454-2426
US

IV. Provider business mailing address

3241 WESTERN BRANCH BLVD
CHESAPEAKE VA
23321-5260
US

V. Phone/Fax

Practice location:
  • Phone: 757-496-9020
  • Fax: 757-481-0638
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME95115
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101243045
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: