Organization
SENTARA MEDICAL GROUP
Active
Other names
First Colonial Diagnostic Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY A TAYLOR (MANAGER)
(757) 252-3344
Entity
Organization
Contact information
Practice address
1080 FIRST COLONIAL RD, SUITE 100A, VIRGINIA BEACH, VA 23454-2406
(757) 395-6464
Mailing address
1080 FIRST COLONIAL RD, SUITE 100A, VIRGINIA BEACH, VA 23454-2406
(757) 395-6464
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49D0981411
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
190002093
MEDICARE PIN
VA
01
—
P00393284
RR MEDICARE PIN
VA
Enumeration date
04/08/2009
Last updated
11/28/2011
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