Healthcare Provider Details

I. General information

NPI: 1982884557
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2007
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 305
SUFFOLK VA
23434-8151
US

IV. Provider business mailing address

2790 GODWIN BLVD STE 305
SUFFOLK VA
23434-8151
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-1600
  • Fax: 757-510-9119
Mailing address:
  • Phone: 757-395-1600
  • Fax: 757-510-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

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