Provider Demographics
NPI:1578683934
Name:LANE, THOMAS W (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:W
Last Name:LANE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 111D
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-434-7020
Mailing Address - Fax:610-434-7802
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 111D
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-434-7020
Practice Address - Fax:610-434-7802
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005998L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALA669551OtherBLUE SHIELD PROVIDER #
PA50016330OtherCAPITAL BLUE CROSS-GROUP
PAP3179629OtherOXFORD PROVIDER #
PA15563000OtherMAGELLAN PROVIDER #
PA50016329OtherCAPITAL BLUE CROSS IND
PA550010003484OtherPACIFICARE
PA669551Medicare ID - Type UnspecifiedMEDICARE PROVIDER #