Provider Demographics
NPI:1477546018
Name:LANE, STEVEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:E
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 1:19 WOODLAND ST
Mailing Address - Street 2:SUITE 47
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-2372
Mailing Address - Country:US
Mailing Address - Phone:860-525-4005
Mailing Address - Fax:860-525-4839
Practice Address - Street 1:19 WOODLAND ST
Practice Address - Street 2:SUITE 35
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2372
Practice Address - Country:US
Practice Address - Phone:860-525-1234
Practice Address - Fax:860-278-8782
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028814207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
2083428OtherAETNA
CT001288142Medicaid
0004260727OtherAETNA
00128814203OtherANTHEM BCBS
060052223OtherRAILROAD MEDICARE
010028814CT01OtherANTHEM BCBS
CT727454OtherCONNECTICARE
D09433167OtherTRICARE/CHAMPUS
CTHA8595OtherOXFORD
CT001288142Medicaid
CT727454OtherCONNECTICARE