Healthcare Provider Details

I. General information

NPI: 1952727588
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 09/23/2014
Certification Date:
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: 757-252-4200
  • Fax: 757-410-7993
Mailing address:
  • Phone: 757-252-4200
  • Fax: 757-410-7993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA

VIII. Authorized Official

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