Healthcare Provider Details

I. General information

NPI: 1376562926
Provider Name (Legal Business Name): MICHELLE L BARTIMOCCIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2088 PRINCESS ANNE RD
VIRGINIA BEACH VA
23456-4014
US

IV. Provider business mailing address

2088 PRINCESS ANNE RD
VIRGINIA BEACH VA
23456-4014
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-6700
  • Fax: 757-668-6680
Mailing address:
  • Phone: 757-668-6700
  • Fax: 757-668-6680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101235698
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: