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General NPI Number Information
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NPI Number | 1710304027
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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 | 03/25/2014
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD STE 110
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 35-238-8807
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Fax | 757-648-1954
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Provider Business Mailing Address
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Address Line | 2280 OPITZ BLVD STE 110
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-523-8880
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Fax | 855-462-1102
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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 | 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 #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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