Healthcare Provider Details

I. General information

NPI: 1689464463
Provider Name (Legal Business Name): MARK ANTHONY JENKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1074 S STATE STREET BAYHEALTH FAMILY MEDICINE
DOVER DE
19901
US

IV. Provider business mailing address

400 N DUPONT HWY APT J14
DOVER DE
19901
US

V. Phone/Fax

Practice location:
  • Phone: 302-725-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC70018969
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: