SENTARA MEDICAL GROUP (NPI# 1083073464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083073464 |
| Entity Type | Organization |
| Organization Name | SENTARA MEDICAL GROUP |
| Other Organization Name | SENTARA VASCULAR SPECIALISTS |
| Practice Address |
3920 Bridge Rd Ste 202 Suffolk VA 23435-1117 |
| Practice Telephone | 7573951600 |
| Practice Fax Number | 7575109136 |
| Mailing Telephone | 7573951600 |
| Mailing Fax Number | 7575109136 |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |
| Authorized Official Name | CINDY A TAYLOR (MANAGER) |
| Authorized Official Telephone | 7572522765 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | MEDICARE GROUP NUMBER | C02033 | 01 |
| Other Name | Type Code |
|---|---|
| Sentara Vascular Specialists | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811533375 | Sentara Medical Group | Internal Medicine | 1101 First Colonial Rd Ste 300, Virginia Beach, VA 23454-2409 | 2019-11-20 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1336627207 | Sentara Medical Group | Emergency Medicine | 844 Kempsville Rd Ste 103, Norfolk, VA 23502 | 2018-08-02 |
| 1073010369 | Sentara Medical Group | Preventive Medicine | 2760 Godwin Blvd Ste 101, Suffolk, VA 23434-8501 | 2018-04-12 |
| 1376043489 | Sentara Medical Group | Internal Medicine | 301 Riverview Ave Ste 670, Norfolk, VA 23510-1065 | 2018-02-15 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1558879346 | Sentara Medical Group | Family Medicine | 301 Riverview Ave Ste 930, Norfolk, VA 23510-1068 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1265954747 | Sentara Medical Group | Internal Medicine | 1933 Edwin Dr Ste 208a, Chesapeake, VA 23322-6531 | 2017-07-17 |
| 1487195111 | Sentara Medical Group | Clinical Medical Laboratory | 1933 Edwin Dr, Suite 104, Chesapeake, VA 23322-6531 | 2017-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Sentara Medical Group | 835 Glenrock Road, Norfolk, Virginia 23502 |
| System for Award Management (SAM) Entities | SENTARA MEDICAL GROUP | 863 Glenrock Rd Ste 208, Norfolk, VA 23502-3701 |
| North Carolina Corporations | Sentara medical Group | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Street Address |
3920 BRIDGE RD STE 202 |
| City | SUFFOLK |
| State | VA |
| Zip Code | 23435-1117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891794863 | Dena R Hall | Family Medicine | 3920 Bridge Rd, Bldg A Ste 207, Suffolk, VA 23435-1117 | 2005-07-20 |
| 1871042069 | Kirstin Grant | Physician Assistant | 3920 Bridge Rd, Suffolk, VA 23435-1117 | 2016-09-28 |
| 1497100911 | Lynne Maka | Physician Assistant | 3920 Bridge Rd, Suffolk, VA 23435-1117 | 2016-05-03 |
| 1134551963 | Angela Bowers Mabalot | Physical Therapist | 3920 Bridge Rd, Suffolk, VA 23435-1107 | 2013-08-02 |
| 1376660951 | Sentara Medical Group | Durable Medical Equipment & Medical Supplies | 3920 Bridge Rd, Bldg. A, Ste. 207, Suffolk, VA 23435-1117 | 2007-03-26 |
| 1891744603 | Prashanthi Bora Koduri | Family Medicine | 3920 Bridge Rd, Bldg A, Ste. 207, Suffolk, VA 23435-1117 | 2006-05-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902423700 | Sean Eric Surber | Physical Therapist | 5818 D Harbour View Blvd., Suite 150, Suffolk, VA 23435 | 2020-06-29 |
| 1871158691 | Lumen Flux Pllc | Dentist | 5501 Bennett's Pasture Road, Suite D, Suffolk, VA 23435 | 2019-05-07 |
| 1588175970 | Louisa Catherine Korte | Anesthesiology | 3107 Summerhouse Drive, Suffolk, VA 23435 | 2017-10-12 |
| 1134648686 | Nicole Short Brown | Non-emergency Medical Transport (VAN) | 782 D Bennetts Meadow Lane, Suffolk, VA 23435 | 2017-09-15 |
| 1104346923 | Southerncare, Inc. | Hospice Care, Community Based | 1037 Champions Way Ste 600, Suffolk, VA 23435 | 2017-06-22 |
| 1801245329 | Usn | Military Hospital | 3602 Traverse Circle, Suffolk, VA 23435 | 2016-06-06 |
| 1366836173 | Vernon Johnson | Counselor | 6805 Castlewood Avenue, Suffolk, VA 23435 | 2015-03-19 |
| 1265776751 | Sister's Developing Growth & Change, LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 6101 Bradford Drive #b, Suffolk, VA 23435 | 2012-11-21 |
| 1770899247 | Lefcoe, Weinstein, Sachs, Schiff & Associates | Dentist | 210 Meadow View Boulevard, Suffolk, VA 23435 | 2010-08-23 |
| 1770805178 | Nikkiah Wyatt Smith | Counselor | 5705 Lee Farm Ln Ste D, Suffolk, VA 23435 | 2010-02-25 |
| Find all providers in zip 23435 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982884557 | Sentara Medical Group | Surgery | 2790 Godwin Blvd, Ste 305, Suffolk, VA 23434-8151 | 2007-11-12 |
| 1770770380 | Genesis Aesthetic Face and Vein Specialists, PC | Surgery | 1500 Breezeport Way, Suite 100, Suffolk, VA 23435-3727 | 2007-09-27 |
| 1730389859 | Surgical Specialties, Inc. | Surgery | 2790 Godwin Blvd, Suite 225, Suffolk, VA 23434-8151 | 2007-07-18 |
| 1598985459 | Joseph Peter Barreca Jr. | Surgery | 4868 Bridge Rd, Suffolk, VA 23435-2048 | 2007-04-25 |
| 1649334343 | Howard Hamilton Harris IIi | Surgery | 2790 Godwin Blvd, Suite 225, Suffolk, VA 23434-8151 | 2006-12-20 |
| 1114925500 | Chad M Mckenzie | Surgery | 5818 Harbour View Blvd, Ste 240, Suffolk, VA 23435 | 2005-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124670930 | Usa Vein Clinics of Chantilly LLC | Surgery | 3914 Centreville Rd Ste 125, Chantilly, VA 20151-3289 | 2019-07-11 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1972980761 | Carlos Jose Torres-medina | Surgery | 500 J Clyde Morris Blvd # 603, Newport News, VA 23601-1929 | 2015-04-30 |
| 1306280128 | Justin Marc Milligan | Surgery | 397 Little Neck Rd Ste 120, Virginia Beach, VA 23452-5774 | 2013-04-23 |
| 1578817938 | Clinch Valley Vascular Surgical Assoc., Pllc | Surgery | 6719 Gov. G.c. Peery Highway, Suite 2600, Richlands, VA 24641 | 2012-11-06 |
| 1346503463 | Mid Atlantic Vascular Holding, LLC | Surgery | 1415 Eastridge Rd, Richmond, VA 23229-5501 | 2012-06-22 |
| 1265791297 | Vascular Surgery Group | Surgery | 850 Chistensen Court, Great Falls, VA 22066 | 2012-05-11 |
| 1902122922 | Hao Duy Pham | Surgery | 6719 Governor Gc Peery Hwy Ste 2600, Richlands, VA 24641 | 2010-04-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.