Provider Demographics
NPI:1689989709
Name:SENTARA MEDICAL GROUP
Entity Type:Organization
Organization Name:SENTARA MEDICAL GROUP
Other - Org Name:SENTARA INTERNAL MEDICINE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-252-3344
Mailing Address - Street 1:301 RIVERVIEW AVE
Mailing Address - Street 2:SUITE 920
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1068
Mailing Address - Country:US
Mailing Address - Phone:757-252-9320
Mailing Address - Fax:757-510-9289
Practice Address - Street 1:301 RIVERVIEW AVE
Practice Address - Street 2:SUITE 920
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1068
Practice Address - Country:US
Practice Address - Phone:757-252-9320
Practice Address - Fax:757-510-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty