Provider Demographics
NPI:1174608277
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 1:5249 PROVIDENCE ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464
Mailing Address - Country:US
Mailing Address - Phone:757-467-3900
Mailing Address - Fax:757-467-3158
Practice Address - Street 1:5249 PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464
Practice Address - Country:US
Practice Address - Phone:757-467-3900
Practice Address - Fax:757-467-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005901898Medicaid
VACK5559OtherRAILROAD MEDICARE
VACK5559OtherRAILROAD MEDICARE