Provider Demographics
NPI:1477589539
Name:LANE., KIMBERLY M (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:M
Last Name:LANE.
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE.
Mailing Address - Street 2:UVM MEDICAL CENTER - ANESTHESIOLOGY
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-2415
Mailing Address - Fax:802-847-5324
Practice Address - Street 1:111 COLCHESTER AVE.
Practice Address - Street 2:UVM MEDICAL CENTER - ANESTHESIOLOGY
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-2415
Practice Address - Fax:802-847-5324
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042.0013233207L00000X
RIMD11720207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI059004095Medicare ID - Type UnspecifiedPROVIDER NUMBER
RIH90476Medicare UPIN