Provider Demographics
NPI:1396740163
Name:LUTINS, JAY ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ALLAN
Last Name:LUTINS
Suffix:
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 1:1000 BOWER HILL ROAD
Mailing Address - Street 2:ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1873
Mailing Address - Country:US
Mailing Address - Phone:412-924-2548
Mailing Address - Fax:
Practice Address - Street 1:1145 BOWER HILL RD STE 105
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1346
Practice Address - Country:US
Practice Address - Phone:412-579-6194
Practice Address - Fax:412-572-6195
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16732208800000X
PAMD039287E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007761350001Medicaid
PA1007761350001Medicaid
PA697393Medicare ID - Type Unspecified