Healthcare Provider Details

I. General information

NPI: 1376853978
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD SUITE 200A
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

850 KEMPSVILLE RD SUITE 200A
NORFOLK VA
23502-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-5910
  • Fax: 757-466-0321
Mailing address:
  • Phone: 757-261-5910
  • Fax: 757-466-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

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