Provider Demographics
NPI:1225017874
Name:JENKINS, MARY BUFFINGTON (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BUFFINGTON
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BUFFINGTON
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:97 GREAT TEAYS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:SCOTT DEPOT
Practice Address - State:WV
Practice Address - Zip Code:25560-9816
Practice Address - Country:US
Practice Address - Phone:304-757-6999
Practice Address - Fax:304-757-3252
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1225017874Medicaid
WV4592027OtherAETNA
WV001721065OtherMS BCBS
WV2001307000Medicaid
WVP00017537OtherRR MEDICARE
2030722Medicare PIN
WV2001307000Medicaid
WVWV2453EMedicare PIN
WVWV2453FMedicare PIN
2030727Medicare PIN
WV2030728Medicare PIN
G19388Medicare UPIN
WV001721065OtherMS BCBS
2030723Medicare PIN
2030726Medicare PIN
WVWV2453CMedicare PIN
2030725Medicare PIN
2030724Medicare PIN
WVP00017537OtherRR MEDICARE
WVWV2453BMedicare PIN