Healthcare Provider Details

I. General information

NPI: 1689792095
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20209 SENTARA WAY SUITE 200
CARROLLTON VA
23314-3575
US

IV. Provider business mailing address

20209 SENTARA WAY SUITE 200
CARROLLTON VA
23314-3575
US

V. Phone/Fax

Practice location:
  • Phone: 757-542-2000
  • Fax: 757-542-2001
Mailing address:
  • Phone: 757-542-2000
  • Fax: 757-542-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CINDY A TAYLOR
Title or Position: MANAGER
Credential:
Phone: 757-252-3344