MEDICARE: DR. KIMBERLY ANN SMITH GRIFFIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101058374	VA
2	207R00000X	Internal Medicine Physician	0101058374	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080169571	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396708665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY ANN SMITH GRIFFIN M.D.

Provider Business Mailing Address
First Line	:	1300 SENTARA PARK # 3
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5884
Country	:	US
Telephone Number	:	757-252-3050
Fax Number	:	757-222-3106

Provider Business Practice Location Address
First Line	:	1300 SENTARA PARK # 3
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5884
Country	:	US
Telephone Number	:	757-252-3050
Fax Number	:	757-222-3106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2006
Last Update Date	:	12/29/2023

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