Healthcare Provider Details

I. General information

NPI: 1407515869
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 12/14/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SENTARA CIR STE 201B
WILLIAMSBURG VA
23188-5716
US

IV. Provider business mailing address

400 SENTARA CIR STE 201B
WILLIAMSBURG VA
23188-5716
US

V. Phone/Fax

Practice location:
  • Phone: 757-345-4655
  • Fax: 757-390-4892
Mailing address:
  • Phone: 757-345-4655
  • Fax: 757-390-4892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DORIS PRINCE
Title or Position: DIRECTOR
Credential:
Phone: 757-983-5475