Provider Demographics
NPI:1265827752
Name:LANE, JESSICA R (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 780125
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0125
Mailing Address - Country:US
Mailing Address - Phone:804-922-4844
Mailing Address - Fax:
Practice Address - Street 1:1000 E BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1930
Practice Address - Country:US
Practice Address - Phone:804-828-9165
Practice Address - Fax:804-828-0374
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2023-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA178025207T00000X
VA0101278483207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery