Provider Demographics
NPI:1568681336
Name:LANE, STACY (DO)
Entity Type:Individual
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First Name:STACY
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:DO
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Other - Middle Name:
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Mailing Address - Street 1:127 ANDERSON ST
Mailing Address - Street 2:SUITE 101 TIMBER COURT
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5803
Mailing Address - Country:US
Mailing Address - Phone:412-322-4151
Mailing Address - Fax:844-389-1405
Practice Address - Street 1:127 ANDERSON ST
Practice Address - Street 2:SUITE 101 TIMBER COURT
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5803
Practice Address - Country:US
Practice Address - Phone:412-322-4151
Practice Address - Fax:844-389-1405
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS012906207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009958930004Medicaid
OH2750741Medicaid
WV3810009044Medicaid
PA080755NHGMedicare PIN
PA1009958930004Medicaid