Basic Information
| Provider Information | |||||||||
| NPI: | 1447309992 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TONKIN | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2041 GEORGIA NW AVE | ||||||||
| Address2: | 4TH FLOOR 4C02 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200600001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2028651314 | ||||||||
| FaxNumber: | 2028651647 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 CLEARFIELD AVE | ||||||||
| Address2: | |||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234621815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574575100 | ||||||||
| FaxNumber: | 7578197762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 02/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 23542 | OK | N | Allopathic & Osteopathic Physicians | Urology | 2088P0231X | 43980 | KY | N | Allopathic & Osteopathic Physicians | Urology | Pediatric Urology | 208800000X | MD048691 | DC | Y | Allopathic & Osteopathic Physicians | Urology | 208800000X | 0101243692 | VA | N | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 201006720 | 05 | IN | MEDICAID | 50030679 | 01 | KY | PASSPORT HEALTH PLAN | OTHER | 7100140700 | 05 | KY | MEDICAID |