Healthcare Provider Details

I. General information

NPI: 1609331867
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WILLIAMSBURG LANDING DR
WILLIAMSBURG VA
23185-3779
US

IV. Provider business mailing address

5700 WILLIAMSBURG LANDING DR
WILLIAMSBURG VA
23185-3779
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-6525
  • Fax: 757-565-6551
Mailing address:
  • Phone: 757-565-6525
  • Fax: 757-565-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CINDY TAYLOR
Title or Position: PROJECT MANAGER
Credential:
Phone: 757-252-2765