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General NPI Number Information
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NPI Number | 1265617864
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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 | 01/02/2008
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Last Update Date | 10/05/2016
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Provider Practice Location Address
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Address Line | 1950 GLENN MITCHELL DR SUITE 310
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-0019
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Country | US
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Telephone | 757-507-0400
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Fax |
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Provider Business Mailing Address
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Address Line | 1950 GLENN MITCHELL DR SUITE 310
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-0019
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Country | US
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Telephone | 757-507-0400
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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 | 757-252-2765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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