MEDICARE: AARON BRICE LANE MD

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	207V00000X	Obstetrics & Gynecology Physician	MD426749	PA
2	207Q00000X	Family Medicine Physician	MD426749	PA

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	:	1770508293
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON BRICE LANE MD

Provider Business Mailing Address
First Line	:	PO BOX 300
Second Line	:	4TH & WILLOW STREET
City	:	LEBANON
State	:	PA
Zip	:	17042-0300
Country	:	US
Telephone Number	:	717-272-4190
Fax Number	:	717-675-2743

Provider Business Practice Location Address
First Line	:	30 N 4TH ST
Second Line	:	2ND FLOOR
City	:	LEBANON
State	:	PA
Zip	:	17046-5606
Country	:	US
Telephone Number	:	717-274-0474
Fax Number	:	717-274-0673

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	12/20/2022

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