Provider Demographics
NPI:1629092184
Name:JENKINS, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:JENKINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1818 RICHARDSON DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5451
Mailing Address - Country:US
Mailing Address - Phone:336-634-0095
Mailing Address - Fax:336-616-0320
Practice Address - Street 1:1818 RICHARDSON DR
Practice Address - Street 2:SUITE E
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5451
Practice Address - Country:US
Practice Address - Phone:336-634-0095
Practice Address - Fax:336-616-0320
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-08-17
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Provider Licenses
StateLicense IDTaxonomies
NC9400533208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC45870OtherBCBS
NC2001733OtherMEDICARE
NC8284OtherPARTNERS MEDICARE CHOICE
NC8945870Medicaid
NCD44070Medicare UPIN