Healthcare Provider Details

I. General information

NPI: 1376660951
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BRIDGE RD BLDG. A, STE. 207
SUFFOLK VA
23435-1117
US

IV. Provider business mailing address

3920 BRIDGE RD BLDG. A, STE. 207
SUFFOLK VA
23435-1117
US

V. Phone/Fax

Practice location:
  • Phone: 757-932-2200
  • Fax: 757-983-2201
Mailing address:
  • Phone: 757-932-2200
  • Fax: 757-983-2201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

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