Healthcare Provider Details

I. General information

NPI: 1245357813
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: 03/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2859 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-7613
US

IV. Provider business mailing address

2859 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-7613
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-1300
  • Fax: 757-226-0247
Mailing address:
  • Phone: 757-395-1300
  • Fax: 757-226-0247

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 Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
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: 757-252-2765