MEDICARE: JARED WILSON LUKE PA-C

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	363A00000X	Physician Assistant	MA060528	PA

General Provider Information

NPI Number	:	1366900607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARED WILSON LUKE PA-C

Provider Business Mailing Address
First Line	:	501 OFFICE CENTER DR STE 195
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3268
Country	:	US
Telephone Number	:	215-836-7900
Fax Number	:	215-836-7923

Provider Business Practice Location Address
First Line	:	501 OFFICE CENTER DR STE 195
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3268
Country	:	US
Telephone Number	:	215-836-7900
Fax Number	:	215-836-7923

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

Provider Enumeration Date	:	03/06/2019
Last Update Date	:	11/05/2020

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