Organization
SENTARA MEDICAL GROUP
Active
Other names
Sentara Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
DORIS PRINCE (DIRECTOR)
(757) 983-5475
Entity
Organization
Contact information
Practice address
3920A BRIDGE RD STE 204, SUFFOLK, VA 23435-1117
(757) 827-2202
(757) 510-9198
Mailing address
3920 A BRIDGE RD, STE 204, SUFFOLK, VA 23435-1117
(757) 827-2202
(757) 510-9198
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
2084N0400X
Neurology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
213E00000X
Podiatrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C02033
MEDICARE GROUP NUMBER
VA
Enumeration date
09/15/2011
Last updated
09/13/2022
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