Healthcare Provider Details

I. General information

NPI: 1669923298
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8610
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8610
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-9015
  • Fax: 757-388-6106
Mailing address:
  • Phone: 757-252-9015
  • Fax: 757-388-6106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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