MEDICARE: GERALD W. LANE D.O.

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	207Q00000X	Family Medicine Physician	34-00-4829	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043254931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD W. LANE D.O.

Provider Business Mailing Address
First Line	:	5250 BETHEL REED PARK
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1811
Country	:	US
Telephone Number	:	614-451-8770
Fax Number	:	614-451-2291

Provider Business Practice Location Address
First Line	:	1275 OLENTANGY RIVER RD
Second Line	:	SUITE 202
City	:	COLUMBUS
State	:	OH
Zip	:	43212-3119
Country	:	US
Telephone Number	:	614-946-3588
Fax Number	:	614-204-3884

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	06/19/2008

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Directions to “ GERALD W. LANE D.O.” Practice Location

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