Provider Demographics
NPI:1063453744
Name:JENKINS, TIMOTHY F (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:F
Last Name:JENKINS
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 1:1803 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1713
Mailing Address - Country:US
Mailing Address - Phone:610-328-9446
Mailing Address - Fax:610-328-6152
Practice Address - Street 1:1803 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1713
Practice Address - Country:US
Practice Address - Phone:610-328-9446
Practice Address - Fax:610-328-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019730E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA068742Medicare ID - Type Unspecified
PAC28874Medicare UPIN