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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
1363LP2300XPrimary Care Nurse Practitioner
2207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1831733237
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENTARA MEDICAL GROUP
Provider Business Mailing Address
First Line : 4439 VIRGINIA BEACH BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-3100
Country : US
Telephone Number : 757-252-0590
Fax Number :
Provider Business Practice Location Address
First Line : 4439 VIRGINIA BEACH BLVD
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23462-3100
Country : US
Telephone Number : 757-252-0590
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : DORIS PRINCE
Credential :
Telephone Number : 757-252-2760
Provider Enumeration Date : 10/30/2019
Last Update Date : 10/30/2019

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Directions to “SENTARA MEDICAL GROUP ” Practice Location

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