Healthcare Provider Details

I. General information

NPI: 1801349048
Provider Name (Legal Business Name): MATTHEW DAVID LUKASAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2016
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 S 4TH ST
LEBANON PA
17042-6111
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-7500
  • Fax:
Mailing address:
  • Phone: 717-270-7688
  • Fax: 717-270-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberOA003827
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: