Healthcare Provider Details

I. General information

NPI: 1912941089
Provider Name (Legal Business Name): MARK KARIM LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 WAYNE ST STE 200
MARIETTA OH
45750-3300
US

IV. Provider business mailing address

611 2ND ST
MARIETTA OH
45750-2123
US

V. Phone/Fax

Practice location:
  • Phone: 740-374-6030
  • Fax: 740-374-6029
Mailing address:
  • Phone: 740-373-8756
  • Fax: 740-373-0091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29014
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35.136629
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: