Healthcare Provider Details

I. General information

NPI: 1285925545
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 11/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE SUITE 100A
NEWPORT NEWS VA
23606-2565
US

IV. Provider business mailing address

11803 JEFFERSON AVE SUITE 100A
NEWPORT NEWS VA
23606-2565
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-1887
  • Fax: 757-594-1884
Mailing address:
  • Phone: 757-594-1887
  • Fax: 757-594-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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