Individual
MATTHEW J BAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 GRESHAM DR, SUITE 1100, NORFOLK, VA 23507-1904
(757) 388-6200
(757) 388-6201
Mailing address
PO BOX 936, NORFOLK, VA 23501-0936
(757) 388-6200
(757) 388-6201
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
0101245661
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
-004
TRICARE/CHAMPUS
VA
01
—
10047408
SENTARA OPTIMA HEALTH
VA
01
—
11764
BC/BS
NC
05
—
1659386076
—
VA
01
—
373342
ANTHEM BC/BS (GRESHAM DR.)
VA
01
—
373343
ANTHEM BC/BS (FIRST COLONIAL RD.)
VA
05
—
5911764
—
NC
01
—
PAR
AETNA
VA
Enumeration date
07/31/2006
Last updated
01/28/2015
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