Provider Demographics
NPI:1538138870
Name:JENKINS, DONALD
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10713 CORDAGE WALK
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-992-0064
Mailing Address - Fax:
Practice Address - Street 1:10713 CORDAGE WALK
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3642
Practice Address - Country:US
Practice Address - Phone:410-992-0064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD005216208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH31991Medicare UPIN