Healthcare Provider Details

I. General information

NPI: 1083801294
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR SUITE 200
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

3000 COLISEUM DR SUITE 200
HAMPTON VA
23666-5963
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-7280
  • Fax: 757-224-3541
Mailing address:
  • Phone: 757-736-7280
  • Fax: 757-224-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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