MEDICARE: KEN J TOMPKINS MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	013XM	OTHER	NC	CLAIMS PROCESSING CONTRACTOR S
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538311501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEN J TOMPKINS MD PC

Provider Business Mailing Address
First Line	:	2206 EXECUTIVE DR STE F
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-825-1846
Fax Number	:	757-825-1587

Provider Business Practice Location Address
First Line	:	2206 EXECUTIVE DR STE F
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-2583
Country	:	US
Telephone Number	:	757-825-1846
Fax Number	:	757-825-1587

Authorized Official
Title or Position	:	OWNER
Name	:	KEN J TOMPKINS
Credential	:	M.D.
Telephone Number	:	757-825-1440

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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