Provider Demographics
NPI:1437778388
Name:STEINKAMP, JACKSON (MD)
Entity Type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:
Last Name:STEINKAMP
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 1:110 ELM ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4626
Mailing Address - Country:US
Mailing Address - Phone:401-443-4992
Mailing Address - Fax:401-537-7241
Practice Address - Street 1:43 JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1027
Practice Address - Country:US
Practice Address - Phone:401-941-2830
Practice Address - Fax:401-941-6886
Is Sole Proprietor?:No
Enumeration Date:2020-04-10
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD18960207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine