Provider Demographics
NPI:1447309992
Name:TONKIN, JEREMY B (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:B
Last Name:TONKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 GEORGIA NW AVE
Mailing Address - Street 2:4TH FLOOR 4C02
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20060-0001
Mailing Address - Country:US
Mailing Address - Phone:202-865-1314
Mailing Address - Fax:202-865-1647
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-457-5100
Practice Address - Fax:757-819-7762
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23542208800000X
KY439802088P0231X
DCMD048691208800000X
VA0101243692208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201006720Medicaid
KY50030679OtherPASSPORT HEALTH PLAN
KY7100140700Medicaid
KYP400027334Medicare PIN
KY7100140700Medicaid