Healthcare Provider Details

I. General information

NPI: 1245626266
Provider Name (Legal Business Name): JORDAN LUKE ALLEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JORDAN RINDERLE

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 09/04/2021
Certification Date: 09/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKS LN STE 220
JEFFERSON HILLS PA
15025-3761
US

IV. Provider business mailing address

1200 BROOKS LN STE 220
JEFFERSON HILLS PA
15025-3761
US

V. Phone/Fax

Practice location:
  • Phone: 412-469-1002
  • Fax: 412-469-8925
Mailing address:
  • Phone: 412-469-1002
  • Fax: 412-469-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD471240
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier14948646
Identifier TypeOTHER
Identifier State
Identifier IssuerCAQH
# 2
Identifier103807585
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: