Healthcare Provider Details

I. General information

NPI: 1568692879
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 FIRST COLONIAL RD STE 305
VIRGINIA BEACH VA
23454-2406
US

IV. Provider business mailing address

2859 VIRGINIA BEACH BLVD SUITE 101
VIRGINIA BEACH VA
23452-7613
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-5680
  • Fax: 757-388-5681
Mailing address:
  • Phone: 757-388-5680
  • Fax: 757-388-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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