1033444039 NPI number — SENTARA MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033444039 NPI number — SENTARA MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENTARA MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033444039
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SENTARA CIR
Provider Second Line Business Mailing Address:
STE 320A
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23188-5716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-395-3975
Provider Business Mailing Address Fax Number:
757-510-9190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SENTARA CIR
Provider Second Line Business Practice Location Address:
STE 320A
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23188-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-395-3975
Provider Business Practice Location Address Fax Number:
757-510-9190
Provider Enumeration Date:
10/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
757-252-3344

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C02033 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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