Healthcare Provider Details

I. General information

NPI: 1922772813
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N MILITARY HWY STE 100
NORFOLK VA
23502-3652
US

IV. Provider business mailing address

824 N MILITARY HWY STE 100
NORFOLK VA
23502-3652
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3198
  • Fax: 833-470-0791
Mailing address:
  • Phone: 757-388-3198
  • Fax: 833-470-0791

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 Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 757-983-5475