Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | D55032 | MD |
NPI | 1033152079 |
---|---|
Provider Name | Andrew Lane |
First Address | Baltimore, MD 21264-4588 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 11/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
834701800 | (05) | MD |
H14310 | (02) | MD |