Healthcare Provider Details

I. General information

NPI: 1942684097
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7967 KINGS HWY
KING GEORGE VA
22485-7075
US

IV. Provider business mailing address

7967 KINGS HWY
KING GEORGE VA
22485-7075
US

V. Phone/Fax

Practice location:
  • Phone: 540-775-6445
  • Fax: 540-775-6449
Mailing address:
  • Phone: 540-775-6445
  • Fax: 540-775-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: CINDY A TAYLOR
Title or Position: MANAGER
Credential:
Phone: 757-252-2765