Healthcare Provider Details

I. General information

NPI: 1285121095
Provider Name (Legal Business Name): MATTHEW ALAN TOENEBOEHN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BELLINGER BLVD
NORFOLK VA
23511-2213
US

IV. Provider business mailing address

1025 BELLINGER BLVD
NORFOLK VA
23511-2213
US

V. Phone/Fax

Practice location:
  • Phone: 410-980-3361
  • Fax:
Mailing address:
  • Phone: 410-980-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number2019028070
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: