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General NPI Number Information
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NPI Number | 1396613394
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Entity Type | Individual
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Provider Name | JONATHAN CARTER LUCK PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/29/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 111 S FRONT ST
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City | HARRISBURG
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State | PA
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Zip | 17101-2010
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Country | US
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Telephone | 717-782-3131
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Fax |
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Provider Business Mailing Address
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Address Line | 5221 SUMMERFIELD DR
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City | MOUNT JOY
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State | PA
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Zip | 17552-8918
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | PA
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