Healthcare Provider Details

I. General information

NPI: 1225276785
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 VOLVO PKWY STE 210
CHESAPEAKE VA
23320-1602
US

IV. Provider business mailing address

725 VOLVO PKWY STE 210
CHESAPEAKE VA
23320-1602
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-4130
  • Fax: 757-410-9705
Mailing address:
  • Phone: 757-252-4130
  • Fax: 757-410-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 757-983-5475