Healthcare Provider Details

I. General information

NPI: 1689989709
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 RIVERVIEW AVE SUITE 920
NORFOLK VA
23510-1068
US

IV. Provider business mailing address

301 RIVERVIEW AVE SUITE 920
NORFOLK VA
23510-1068
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-9320
  • Fax: 757-510-9289
Mailing address:
  • Phone: 757-252-9320
  • Fax: 757-510-9289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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