Provider Demographics
NPI:1558629816
Name:LANE, MOLLIE (MD)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
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 1:110 IRVING ST NW
Mailing Address - Street 2:DEPT OF PULMONARY DISEASE/CRITICAL CARE MEDICINE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3017
Mailing Address - Country:US
Mailing Address - Phone:202-877-7856
Mailing Address - Fax:202-877-6130
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:DEPT OF PULMONARY DISEASE/CRITICAL CARE MEDICINE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7856
Practice Address - Fax:202-877-6130
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2015-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD043262207R00000X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program