MEDICARE: KIM MARIE PANZARELLA MD

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	207N00000X	Dermatology Physician	0101231763	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	070016578	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	2906423	OTHER	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0300462	OTHER	UNITED HEALTHCARE
4	150946	OTHER	SOUTHERN HEALTH
6	384358	OTHER	ANTHEM

General Provider Information

NPI Number	:	1871593244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MARIE PANZARELLA MD

Provider Business Mailing Address
First Line	:	7201 GLEN FOREST DR STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-3759
Country	:	US
Telephone Number	:	804-549-4030
Fax Number	:	804-549-4032

Provider Business Practice Location Address
First Line	:	280 CHARLES H DIMMOCK PKWY STE 4
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2940
Country	:	US
Telephone Number	:	804-549-4030
Fax Number	:	804-549-4032

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2025

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Directions to “ KIM MARIE PANZARELLA MD” Practice Location

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