Provider Demographics
NPI:1376512640
Name:LANE, JAMES JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:LANE
Suffix:JR
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 1:5 SEVERANCE CIR
Mailing Address - Street 2:SUITE 705
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-1566
Mailing Address - Country:US
Mailing Address - Phone:216-381-1311
Mailing Address - Fax:216-381-2606
Practice Address - Street 1:5 SEVERANCE CIR
Practice Address - Street 2:SUITE 705
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-1566
Practice Address - Country:US
Practice Address - Phone:216-381-1311
Practice Address - Fax:216-381-2606
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-044197174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534505Medicaid
OHD31333Medicare UPIN
0532119Medicare ID - Type Unspecified
OH9335441Medicare ID - Type UnspecifiedGROUP NUMBER