Provider Demographics
NPI:1114173234
Name:KANE, JASON M (LAC, DIPL OM)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:KANE
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 STONECROFT RD
Mailing Address - Street 2:APT E
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3237
Mailing Address - Country:US
Mailing Address - Phone:410-294-7537
Mailing Address - Fax:
Practice Address - Street 1:234 STONECROFT RD
Practice Address - Street 2:APT E
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-3237
Practice Address - Country:US
Practice Address - Phone:410-294-7537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01667171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist