MEDICARE: DR. JENNIFER MARY LANE M.D.

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	208600000X	Surgery Physician	247127	MA

General Provider Information

NPI Number	:	1215920301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER MARY LANE M.D.

Provider Business Mailing Address
First Line	:	91 MONTVALE AVE STE 208
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3649
Country	:	US
Telephone Number	:	781-306-6166
Fax Number	:	781-418-1919

Provider Business Practice Location Address
First Line	:	91 MONTVALE AVE STE 208
Second Line	:
City	:	STONEHAM
State	:	MA
Zip	:	02180-3649
Country	:	US
Telephone Number	:	781-306-6166
Fax Number	:	781-418-1919

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/18/2021

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