MEDICARE: JEFFREY H LANE M.D.

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	207VG0400X	Gynecology Physician	024986	CT

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	:	1366465973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY H LANE M.D.

Provider Business Mailing Address
First Line	:	183 BOSTON POST RD
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-1605
Country	:	US
Telephone Number	:	860-739-7786
Fax Number	:	860-739-6473

Provider Business Practice Location Address
First Line	:	183 BOSTON POST RD
Second Line	:
City	:	EAST LYME
State	:	CT
Zip	:	06333-1605
Country	:	US
Telephone Number	:	860-739-7786
Fax Number	:	860-739-6473

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/01/2008

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