NPIMap

Organization Active NPI

Sentara Medical Group

  • Otolaryngology Physician
  • Suffolk, VA
National Provider Identifier
1629409156
Registry record updated Dec 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
SENTARA MEDICAL GROUP
Practice address
2790 Godwin Blvd
Ste 205
Suffolk, VA 23434-8151
Phone
(757) 934-7753
Fax
(757) 535-1739
NPI assigned
Dec 10, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2013

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
Otolaryngology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

2790 Godwin Blvd
Ste 205
Suffolk, VA 23434-8151

Mailing address

2790 Godwin Blvd
Ste 205
Suffolk, VA 23434-8151
Phone (757) 934-7753

Other identifiers 1

IdentifierTypeStateIssuer
C02033OtherVAMEDICARE GROUP NUMBER

Other names 1

  • Dr. Eugenia M. Gray Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Old Hampton Family Prac188 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

2790 Godwin Blvd
Ste 205
Suffolk, VA 23434
Phone (757) 934-7753

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386633600000",
    "number": "1629409156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD",
            "address_2": "STE 205",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-934-7753",
            "fax_number": "757-535-1739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 GODWIN BLVD",
            "address_2": "STE 205",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234348151",
            "telephone_number": "757-934-7753",
            "fax_number": "757-535-1739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENTARA MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2013-12-10",
        "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": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "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": "Dr. Eugenia M. Gray",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2013; 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.