Provider Demographics
NPI:1598025066
Name:LUTZKANIN, ANDREW III (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LUTZKANIN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:3100 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3548
Practice Address - Country:US
Practice Address - Phone:717-948-5180
Practice Address - Fax:717-948-0488
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT201187207Q00000X
PAMD453806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine