Provider Demographics
NPI:1386786697
Name:SODERBERG, KIMBERLY INGRAM (MD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:INGRAM
Last Name:SODERBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3176 HOLLAND RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2637
Mailing Address - Country:US
Mailing Address - Phone:757-368-7546
Mailing Address - Fax:757-368-3376
Practice Address - Street 1:3176 HOLLAND RD
Practice Address - Street 2:SUITE 103
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-2637
Practice Address - Country:US
Practice Address - Phone:757-368-7546
Practice Address - Fax:757-368-3376
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241129207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology