Provider Demographics
NPI:1295810398
Name:KEN J TOMPKINS MD PC
Entity type:Organization
Organization Name:KEN J TOMPKINS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-467-3900
Mailing Address - Street 1:1157 FIRST COLONIAL ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454
Mailing Address - Country:US
Mailing Address - Phone:757-333-8001
Mailing Address - Fax:757-333-8002
Practice Address - Street 1:1157 FIRST COLONIAL ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454
Practice Address - Country:US
Practice Address - Phone:757-333-8001
Practice Address - Fax:757-333-8002
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEN J TOMPKINS, MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK5559OtherRAILROAD MEDICARE
CK5559OtherRAILROAD MEDICARE