Provider Demographics
NPI:1528053873
Name:LUKASZCZYK, JOHN JAMES (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAMES
Last Name:LUKASZCZYK
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 1:701 OSTRUM ST
Mailing Address - Street 2:STE 202
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:484-526-2200
Mailing Address - Fax:484-526-2398
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 202
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:484-526-2200
Practice Address - Fax:484-526-2398
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036099E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001267239Medicaid
603710Medicare PIN
PA001267239Medicaid