Provider Demographics
NPI:1538311501
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:KEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:TOMPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-825-1440
Mailing Address - Street 1:2206 EXECUTIVE DR STE F
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-2583
Mailing Address - Country:US
Mailing Address - Phone:757-825-1846
Mailing Address - Fax:757-825-1587
Practice Address - Street 1:2206 EXECUTIVE DR STE F
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2583
Practice Address - Country:US
Practice Address - Phone:757-825-1846
Practice Address - Fax:757-825-1587
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEN J TOMPKINS MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013XMOtherCLAIMS PROCESSING CONTRACTOR S
NC89013XMMedicaid
NC013XMOtherCLAIMS PROCESSING CONTRACTOR S
VACK5560Medicare PIN
NCCK5561Medicare PIN
NC2003292Medicare PIN