Provider Demographics
NPI:1376677898
Name:LAMPKIN, JONATHAN T (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:T
Last Name:LAMPKIN
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 1:1331 N ELM ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6302
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:471 E BROAD ST
Practice Address - Street 2:SUITE 1400
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-3842
Practice Address - Country:US
Practice Address - Phone:614-221-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-08-76742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1376677898Medicaid
AL109025Medicaid
AL106975Medicaid
FL0003592Medicaid
AL106976Medicaid
AL106976Medicaid
AL510I300152Medicare PIN
AL510I300151Medicare PIN
AL1376677898Medicaid