Healthcare Provider Details

I. General information

NPI: 1669813507
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 08/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 GLENN MITCHELL DR STE 202
VIRGINIA BEACH VA
23456-0170
US

IV. Provider business mailing address

1925 GLENN MITCHELL DR STE 202
VIRGINIA BEACH VA
23456-0170
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0900
  • Fax: 757-301-6462
Mailing address:
  • Phone: 757-507-0900
  • Fax: 757-301-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal 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: CINDY A TAYLOR
Title or Position: MANAGER
Credential:
Phone: 757-252-3344