Healthcare Provider Details

I. General information

NPI: 1083104459
Provider Name (Legal Business Name): MEGAN ELIZABETH LANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3079
US

IV. Provider business mailing address

2730 S MOODY AVE
PORTLAND OR
97201-5042
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberMD229735
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: