Provider Demographics
NPI:1275725970
Name:MCKANE, ANN VICTORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:VICTORIA
Last Name:MCKANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:MCKANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2165 N LINE ST
Mailing Address - Street 2:
Mailing Address - City:COLMAR
Mailing Address - State:PA
Mailing Address - Zip Code:18915
Mailing Address - Country:US
Mailing Address - Phone:516-528-0135
Mailing Address - Fax:
Practice Address - Street 1:2165 N LINE ST
Practice Address - Street 2:
Practice Address - City:COLMAR
Practice Address - State:PA
Practice Address - Zip Code:18915
Practice Address - Country:US
Practice Address - Phone:215-997-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216858207ZB0001X, 207ZP0102X, 208D00000X
CODR.0047912207ZB0001X
PAMD447351207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY216858OtherLICENSE, NYS DOH
00702970334OtherAMA