Provider Demographics
NPI:1730615816
Name:SENTARA HEALTHCARE
Entity type:Organization
Organization Name:SENTARA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATHLETIC TRAINING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELISIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-741-0845
Mailing Address - Street 1:805 LAFAYETTE TER
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 IRELAND ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-2150
Practice Address - Country:US
Practice Address - Phone:757-727-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-10
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126001920282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital