1225298524 NPI number — DR. JESSICA MARIE LUCKENBAUGH RUBERTONE MD

Table of content: DR. JESSICA MARIE LUCKENBAUGH RUBERTONE MD (NPI 1225298524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225298524 NPI number — DR. JESSICA MARIE LUCKENBAUGH RUBERTONE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCKENBAUGH RUBERTONE
Provider First Name:
JESSICA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225298524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 WALNUT ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
LEMOYNE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17043-1168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-761-0208
Provider Business Mailing Address Fax Number:
717-761-2023

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 KACEY CT
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MECHANICSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17055-9223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-591-0961
Provider Business Practice Location Address Fax Number:
717-591-0980
Provider Enumeration Date:
06/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD442929 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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