Provider Demographics
NPI:1629133699
Name:GARY A LUKEN MD
Entity Type:Organization
Organization Name:GARY A LUKEN MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LUKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-664-1001
Mailing Address - Street 1:41 DOE RUN RD
Mailing Address - Street 2:
Mailing Address - City:MANHEIM
Mailing Address - State:PA
Mailing Address - Zip Code:17545-8553
Mailing Address - Country:US
Mailing Address - Phone:717-664-1001
Mailing Address - Fax:717-664-1003
Practice Address - Street 1:41 DOE RUN RD
Practice Address - Street 2:
Practice Address - City:MANHEIM
Practice Address - State:PA
Practice Address - Zip Code:17545-8553
Practice Address - Country:US
Practice Address - Phone:717-664-1001
Practice Address - Fax:717-664-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037941E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03211600OtherBLUE CROSS
PA0543047OtherBLUE SHIELD
PA0543047OtherBLUE SHIELD
PA033284Medicare ID - Type Unspecified