Healthcare Provider Details

I. General information

NPI: 1902116502
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: 02/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD SUITE 212
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

850 KEMPSVILLE RD SUITE 212
NORFOLK VA
23502-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-5977
  • Fax: 757-275-9913
Mailing address:
  • Phone: 757-261-5977
  • Fax: 757-275-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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