Healthcare Provider Details

I. General information

NPI: 1437363975
Provider Name (Legal Business Name): SENTARA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SENTARA CIR SUITE 102
WILLIAMSBURG VA
23188-5727
US

IV. Provider business mailing address

500 SENTARA CIR SUITE 102
WILLIAMSBURG VA
23188-5727
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-9700
  • Fax: 757-984-9701
Mailing address:
  • Phone: 757-984-9700
  • Fax: 757-984-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

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