Healthcare Provider Details

I. General information

NPI: 1023109170
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 BATTLEFIELD BLVD S SUITE 300
CHESAPEAKE VA
23322-4800
US

IV. Provider business mailing address

633 BATTLEFIELD BLVD S SUITE 300
CHESAPEAKE VA
23322-4800
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-4700
  • Fax: 757-233-4716
Mailing address:
  • Phone: 757-233-4700
  • Fax: 757-233-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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