MEDICARE: SENTARA MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	VA
2	332B00000X	Durable Medical Equipment & Medical Supplies	VA
3	207Q00000X	Family Medicine Physician	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C02033	OTHER	VA	MEDICARE GROUP NUMBER

General Provider Information

NPI Number	:	1396133344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTARA MEDICAL GROUP

Provider Business Mailing Address
First Line	:	816 INDUSTRIAL AVE
Second Line	:	STE 100
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2615
Country	:	US
Telephone Number	:	757-233-9055
Fax Number	:	757-228-5575

Provider Business Practice Location Address
First Line	:	816 INDUSTRIAL AVE
Second Line	:	STE 100
City	:	CHESAPEAKE
State	:	VA
Zip	:	23324-2615
Country	:	US
Telephone Number	:	757-233-9055
Fax Number	:	757-228-5575

Authorized Official
Title or Position	:	MANAGER
Name	:	CINDY A TAYLOR
Credential	:
Telephone Number	:	757-252-3344

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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Directions to “SENTARA MEDICAL GROUP ” Practice Location

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