Healthcare Provider Details

I. General information

NPI: 1013117340
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 09/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD 1ST FLR
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

2800 GODWIN BLVD 1ST FLR
SUFFOLK VA
23434-8038
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4821
  • Fax: 757-934-4276
Mailing address:
  • Phone: 757-934-4821
  • Fax: 757-934-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

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