Organization
SENTARA MEDICAL GROUP
Active
Other names
Sentara Pratt Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
CINDY A TAYLOR (MANAGER)
(757) 252-2765
Entity
Organization
Contact information
Practice address
16463 DAHLGREN RD, KING GEORGE, VA 22485-5810
(540) 644-9505
(540) 644-9508
Mailing address
16463 DAHLGREN RD, KING GEORGE, VA 22485-5810
(540) 644-9505
(540) 644-9508
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
VA
332B00000X
Durable Medical Equipment & Medical Supplies
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02033
MEDICARE GROUP NUMBER
VA
Enumeration date
07/10/2015
Last updated
07/10/2015
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