Healthcare Provider Details

I. General information

NPI: 1962615211
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 FIRST COLONIAL RD SUITE 412
VIRGINIA BEACH VA
23454-2406
US

IV. Provider business mailing address

1080 FIRST COLONIAL RD SUITE 412
VIRGINIA BEACH VA
23454-2406
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-6500
  • Fax: 757-275-9885
Mailing address:
  • Phone: 757-395-6500
  • Fax: 757-275-9885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

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