Provider Demographics
NPI:1245626266
Name:ALLEN, JORDAN LUKE (MD)
Entity type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:LUKE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:RINDERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 BROOKS LN STE 220
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3761
Mailing Address - Country:US
Mailing Address - Phone:412-469-1002
Mailing Address - Fax:412-469-8925
Practice Address - Street 1:1200 BROOKS LN STE 220
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3761
Practice Address - Country:US
Practice Address - Phone:412-469-1002
Practice Address - Fax:412-469-8925
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD471240208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
14948646OtherCAQH
PA103807585Medicaid