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General NPI Number Information
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NPI Number | 1235319849
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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 | 11/12/2007
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Last Update Date | 05/12/2009
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Provider Practice Location Address
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Address Line | 400 W BRAMBLETON AVE SUITE 100
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City | NORFOLK
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State | VA
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Zip | 23510-1115
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Country | US
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Telephone | 757-457-5170
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Fax | 757-626-0768
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Provider Business Mailing Address
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Address Line | 400 W BRAMBLETON AVE SUITE 100
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City | NORFOLK
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State | VA
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Zip | 23510-1115
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Country | US
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Telephone | 757-457-5170
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Fax | 757-626-0768
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | MRS. ARRIE P HINES
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Credential |
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Telephone | 757-252-3339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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