Provider Demographics
NPI:1598724502
Name:LANE, CHRISTINA L (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:L
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3707 CHARLESTOWN RD STE C1
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9254
Mailing Address - Country:US
Mailing Address - Phone:812-944-4575
Mailing Address - Fax:812-944-4886
Practice Address - Street 1:3707 CHARLESTOWN RD STE C1
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9254
Practice Address - Country:US
Practice Address - Phone:812-944-4575
Practice Address - Fax:812-944-4886
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38514208000000X
IN01058950A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200472470AMedicaid
INI02744Medicare UPIN