Organization
SENTARA MEDICAL GROUP
Active
Organization
SENTARA MEDICAL GROUP
Active
Other names
Sentara Specialty Services
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CINDY A TAYLOR (MANAGER)
(757) 252-3344
Entity
Organization
Contact information
Practice address
11803 JEFFERSON AVE, SUITE 100A, NEWPORT NEWS, VA 23606-2565
(757) 594-1887
(757) 594-1884
Mailing address
11803 JEFFERSON AVE, SUITE 100A, NEWPORT NEWS, VA 23606-2565
(757) 594-1887
(757) 594-1884
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02033
MEDICARE GROUP NUMBER
VA
Enumeration date
04/21/2011
Last updated
11/18/2011
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