Healthcare Provider Details

I. General information

NPI: 1992762140
Provider Name (Legal Business Name): LAWRENCE RICHARD JENKYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 COUNTY ROAD
NEW LONDON NH
03257-0000
US

IV. Provider business mailing address

PO BOX 2150
NEW LONDON NH
03257-2150
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-2911
  • Fax: 603-650-0458
Mailing address:
  • Phone: 603-650-8390
  • Fax: 603-650-0458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number6517
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: