1306343306 NPI number — JONATHAN THACHARA LUKE DDS

Table of content: JONATHAN THACHARA LUKE DDS (NPI 1306343306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306343306 NPI number — JONATHAN THACHARA LUKE DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUKE
Provider First Name:
JONATHAN
Provider Middle Name:
THACHARA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

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:
1306343306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 477, 26220 POINT LOOKOUT ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEONARDTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20650-2158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-475-8100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26220 POINT LOOKOUT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEONARDTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20650-3748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-475-8100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2018

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: 1223S0112X , with the licence number:  DS042595 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 16580 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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