Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 7886 | ND |
N | 208600000X | Surgeon | 7886 | ND |
Y | 2086S0129X | Vascular Surgeon | 34.005124 | OH |
N | 2086S0129X | Vascular Surgeon | 7886 | ND |
NPI | 1073600979 |
---|---|
Provider Name | Lane M Lee |
First Address | Marietta, OH 45750-0449 |
Second Address | Marietta, OH 45750-1656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 11/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0827289 | (05) | OH |
10519 | (05) | ND |
3910000637 | (05) | WV |
E93283 | (02) | |
P01297083 | RAILROAD MEDICARE - MHCPI (01) | OH |