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General NPI Number Information
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NPI Number | 1700063013
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Entity Type | Organization
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Legal Business Name | EDWARD M LANE MD PC
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Dates
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Enumeration Date | 01/29/2008
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Last Update Date | 05/13/2013
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Provider Practice Location Address
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Address Line | 4675 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1813
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Country | US
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Telephone | 203-372-0009
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Fax | 203-372-7931
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Provider Business Mailing Address
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Address Line | 4675 MAIN ST
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City | BRIDGEPORT
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State | CT
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Zip | 06606-1813
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Country | US
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Telephone | 203-372-0009
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Fax | 203-372-7931
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Authorized Official
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Title or Position | MANAGER
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Name | MS. IZAMARI GARCIA
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Credential |
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Telephone | 203-372-0009
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 024203
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License Number State | CT
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