Provider Demographics
NPI:1104086743
Name:ISENHOWER, MATTHEW W (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:ISENHOWER
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 1:134 BUSINESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6523
Mailing Address - Country:US
Mailing Address - Phone:757-473-0055
Mailing Address - Fax:757-473-0075
Practice Address - Street 1:600 GRESHAM DR
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:757-473-0055
Practice Address - Fax:757-473-0075
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME112193207L00000X
VA0101246603207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program