Healthcare Provider Details

I. General information

NPI: 1679221246
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 03/14/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6251 E VIRGINIA BEACH BLVD STE 300
NORFOLK VA
23502-2824
US

IV. Provider business mailing address

6251 E VIRGINIA BEACH BLVD STE 300
NORFOLK VA
23502-2824
US

V. Phone/Fax

Practice location:
  • Phone: 757-962-5610
  • Fax: 757-962-5610
Mailing address:
  • Phone: 757-962-5610
  • Fax: 757-962-5610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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