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General NPI Number Information
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NPI Number | 1174766026
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Entity Type | Organization
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Legal Business Name | SENTARA MEDICAL GROUP
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Dates
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Enumeration Date | 04/08/2009
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 1080 FIRST COLONIAL RD SUITE 100A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2406
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Country | US
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Telephone | 757-395-6464
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 FIRST COLONIAL RD SUITE 100A
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2406
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Country | US
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Telephone | 757-395-6464
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CINDY A TAYLOR
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Credential |
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Telephone | 757-252-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 49D0981411
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License Number State | VA
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