Healthcare Provider Details

I. General information

NPI: 1972781508
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5659 PARKWAY DR SUITE 100
GLOUCESTER VA
23061-3792
US

IV. Provider business mailing address

5659 PARKWAY DR SUITE 100
GLOUCESTER VA
23061-3792
US

V. Phone/Fax

Practice location:
  • Phone: 804-210-1005
  • Fax: 804-210-1009
Mailing address:
  • Phone: 804-210-1005
  • Fax: 804-210-1009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
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