Healthcare Provider Details

I. General information

NPI: 1225298524
Provider Name (Legal Business Name): JESSICA MARIE LUCKENBAUGH RUBERTONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KACEY CT SUITE 101
MECHANICSBURG PA
17055-9223
US

IV. Provider business mailing address

3 WALNUT ST SUITE 206
LEMOYNE PA
17043-1168
US

V. Phone/Fax

Practice location:
  • Phone: 717-591-0961
  • Fax: 717-591-0980
Mailing address:
  • Phone: 717-761-0208
  • Fax: 717-761-2023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD442929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: