Provider Demographics
NPI:1366465973
Name:LANE, JEFFREY H (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:H
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:EAST LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06333-1605
Mailing Address - Country:US
Mailing Address - Phone:860-739-7786
Mailing Address - Fax:860-739-6473
Practice Address - Street 1:183 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:EAST LYME
Practice Address - State:CT
Practice Address - Zip Code:06333-1605
Practice Address - Country:US
Practice Address - Phone:860-739-7786
Practice Address - Fax:860-739-6473
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024986207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001249861Medicaid
CTD02580Medicare UPIN
CTC02336Medicare PIN