Healthcare Provider Details

I. General information

NPI: 1073010369
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 GODWIN BLVD STE 101
SUFFOLK VA
23434-8501
US

IV. Provider business mailing address

2760 GODWIN BLVD STE 101
SUFFOLK VA
23434-8501
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4162
  • Fax: 757-934-4246
Mailing address:
  • Phone: 757-934-4162
  • Fax: 757-934-4246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

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