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NPI Code Detail

MEDICARE: SENTARA MEDICAL GROUP

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 License Number State
1332B00000XDurable Medical Equipment & Medical SuppliesVA
2207Q00000XFamily Medicine PhysicianVA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1C02033OTHERVAMEDICARE GROUP NUMBER

General Provider Information

NPI Number : 1750785945
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENTARA MEDICAL GROUP
Provider Business Mailing Address
First Line : 5460 WESLEYAN DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6906
Country : US
Telephone Number : 757-395-1900
Fax Number : 757-995-7373
Provider Business Practice Location Address
First Line : 5460 WESLEYAN DR
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23455-6906
Country : US
Telephone Number : 757-395-1900
Fax Number : 757-995-7373
Authorized Official
Title or Position : MANAGER
Name : CINDY A TAYLOR
Credential :
Telephone Number : 757-252-3344
Provider Enumeration Date : 10/16/2014
Last Update Date : 10/16/2014

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Directions to “SENTARA MEDICAL GROUP ” Practice Location

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