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General NPI Number Information
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NPI Number | 1356523641
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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 | 11/29/2007
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 3000 COLISEUM DR STE 200
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City | HAMPTON
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State | VA
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Zip | 23666-5963
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Country | US
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Telephone | 757-262-1110
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Fax | 757-510-9116
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Provider Business Mailing Address
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Address Line | 3000 COLISEUM DR STE 200
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City | HAMPTON
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State | VA
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Zip | 23666-5963
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Country | US
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Telephone | 757-262-1110
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Fax | 757-510-9116
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. DORIS PRINCE
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Credential |
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Telephone | 757-252-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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