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NPI Code Detail

MEDICARE: RANDOLPH MITCHELL JENKINS JR. M.D.

MEDICARE: RANDOLPH MITCHELL JENKINS JR. M.D.
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
1208100000XPhysical Medicine & Rehabilitation Physician0101261201VA

General Provider Information

NPI Number : 1760878144
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDOLPH MITCHELL JENKINS JR. M.D.
Provider Business Mailing Address
First Line : 95 MEDICAL PARK BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-9280
Country : US
Telephone Number : 804-504-8100
Fax Number :
Provider Business Practice Location Address
First Line : 95 MEDICAL PARK BLVD
Second Line :
City : PETERSBURG
State : VA
Zip : 23805-9280
Country : US
Telephone Number : 804-504-8100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2015
Last Update Date : 05/18/2022

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