Healthcare Provider Details

I. General information

NPI: 1356523641
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR STE 200
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

3000 COLISEUM DR STE 200
HAMPTON VA
23666-5963
US

V. Phone/Fax

Practice location:
  • Phone: 757-262-1110
  • Fax: 757-510-9116
Mailing address:
  • Phone: 757-262-1110
  • Fax: 757-510-9116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DORIS PRINCE
Title or Position: MANAGER
Credential:
Phone: 757-252-2760