Healthcare Provider Details

I. General information

NPI: 1669590154
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: 12/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 COLISEUM DR SUITE 345
HAMPTON VA
23666-5906
US

IV. Provider business mailing address

4000 COLISEUM DR SUITE 345
HAMPTON VA
23666-5906
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-2120
  • Fax: 757-827-2121
Mailing address:
  • Phone: 757-827-2120
  • Fax: 757-827-2121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation 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