Healthcare Provider Details

I. General information

NPI: 1174822563
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 GLENN MITCHELL DR STE 200
VIRGINIA BEACH VA
23456-0019
US

IV. Provider business mailing address

1950 GLENN MITCHELL DR STE 200
VIRGINIA BEACH VA
23456-0019
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0600
  • Fax: 757-689-3785
Mailing address:
  • Phone: 757-507-0600
  • Fax: 757-689-3785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

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