Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 024213 | CT |
NPI | 1033140876 |
---|---|
Provider Name | Dr. Edward Michael Lane |
First Address | New Haven, CT 06511-6624 |
Second Address | Bridgeport, CT 06606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 02/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001242031 | (05) | CT |
B39681 | (02) |