MEDICARE: RONSTON JACKMAN MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1922942234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONSTON JACKMAN MD

Provider Business Mailing Address
First Line	:	PO BOX 1980
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23501-1980
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3640 HIGH ST STE 3B
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23707-3213
Country	:	US
Telephone Number	:	757-397-6344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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