Healthcare Provider Details

I. General information

NPI: 1659540136
Provider Name (Legal Business Name): GERALD LANE D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 OLENTANGY RIVER RD SUITE 202
COLUMBUS OH
43212-3119
US

IV. Provider business mailing address

5250 BETHEL REED PARK
COLUMBUS OH
43220-1811
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-8770
  • Fax: 614-451-2291
Mailing address:
  • Phone: 614-451-8770
  • Fax: 614-451-2291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number34004829
License Number StateOH

VIII. Authorized Official

Name: GERALD LANE
Title or Position: PHYSICIAN
Credential: DO
Phone: 614-451-8770