Provider Demographics
NPI:1194275859
Name:SENTARA MEDICAL GROUP
Entity type:Organization
Organization Name:SENTARA MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:757-252-2765
Mailing Address - Street 1:3600 POINTE CENTER CT
Mailing Address - Street 2:STE 110
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-2669
Mailing Address - Country:US
Mailing Address - Phone:703-523-1750
Mailing Address - Fax:844-518-0708
Practice Address - Street 1:3600 POINTE CENTER CT
Practice Address - Street 2:STE 110
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-2669
Practice Address - Country:US
Practice Address - Phone:703-523-1750
Practice Address - Fax:844-518-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02033Medicare PIN