NPIMap

Organization Active NPI

Sentara Medical Group

Doing business as Potomac Vascular Surgery

  • Vascular Surgery Physician
  • Woodbridge, VA
National Provider Identifier
1093075319
Registry record updated May 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
SENTARA MEDICAL GROUP
Doing business as
Potomac Vascular Surgery
Practice address
2296 Opitz Blvd
Ste 260a
Woodbridge, VA 22191-3300
Phone
(540) 657-8180
NPI assigned
May 21, 2012
Last updated
May 21, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Cindy A Taylor
Title
Manager
Phone
(757) 252-3344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X Primary

Addresses

Primary practice location

2296 Opitz Blvd
Ste 260a
Woodbridge, VA 22191-3300

Mailing address

2296 Opitz Blvd
Ste 260a
Woodbridge, VA 22191-3300
Phone (540) 657-8180

Other identifiers 1

IdentifierTypeStateIssuer
C02033OtherVAMEDICARE GROUP NUMBER

Other names 1

  • Potomac Vascular Surgery Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Invalid Entry188 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2296 Opitz Blvd
Ste 260A
Woodbridge, VA 22191
Phone (540) 657-8180

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1337558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337558400000",
    "number": "1093075319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2296 OPITZ BLVD",
            "address_2": "STE 260A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913300",
            "telephone_number": "540-657-8180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2296 OPITZ BLVD",
            "address_2": "STE 260A",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221913300",
            "telephone_number": "540-657-8180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-21",
        "last_updated": "2012-05-21",
        "status": "A",
        "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",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "C02033",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potomac Vascular Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbridge, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.