Healthcare Provider Details

I. General information

NPI: 1396740163
Provider Name (Legal Business Name): JAY ALLAN LUTINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 BOWER HILL RD STE 105
PITTSBURGH PA
15243-1346
US

IV. Provider business mailing address

1000 BOWER HILL ROAD ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 412-579-6194
  • Fax: 412-572-6195
Mailing address:
  • Phone: 412-924-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number16732
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD039287E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: