MEDICARE: MISS TERESA LYNN LUTKA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	MD422963	PA

General Provider Information

NPI Number	:	1235124215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TERESA LYNN LUTKA MD

Provider Business Mailing Address
First Line	:	2644 BANKSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216
Country	:	US
Telephone Number	:	412-343-7166
Fax Number	:	412-343-4330

Provider Business Practice Location Address
First Line	:	2644 BANKSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216
Country	:	US
Telephone Number	:	412-343-7166
Fax Number	:	412-343-4330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/29/2018

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