Healthcare Provider Details

I. General information

NPI: 1104019389
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GREENWICH RD SUITE 501
VIRGINIA BEACH VA
23462-6542
US

IV. Provider business mailing address

5555 GREENWICH RD SUITE 501
VIRGINIA BEACH VA
23462-6542
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-3344
  • Fax:
Mailing address:
  • Phone: 757-252-3344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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