Provider Demographics
NPI:1083913339
Name:BERNENS, MATTHEW DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:DONALD
Last Name:BERNENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:EVMS MEDICAL GROUP
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:600 GRESHAM DR STE 8630
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101255467207R00000X, 207RC0200X, 390200000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10130540OtherOPTIMA HEALTH
VA1083913339Medicaid
VA1083913339OtherCOVENTRY NETWORK
VAPAROtherVIRGINIA HEALTH NETWORK
VA520691OtherANTHEM BC/BS
VAPAROtherAETNA
NC1083913339Medicaid
VAPAROtherUSA MANAGED CARE
VA-028OtherTRICARE/CHAMPUS
VA1083913339OtherCIGNA
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA1083913339OtherVIRGINIA PREMIER HEALTH PLAN
VA1083913339OtherUNITED HEALTHCARE
VAPAROtherCORVEL