Provider Demographics
NPI:1659540136
Name:GERALD LANE D.O.
Entity Type:Organization
Organization Name:GERALD LANE D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-451-8770
Mailing Address - Street 1:5250 BETHEL REED PARK
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1811
Mailing Address - Country:US
Mailing Address - Phone:614-451-8770
Mailing Address - Fax:614-451-2291
Practice Address - Street 1:1275 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3119
Practice Address - Country:US
Practice Address - Phone:614-451-8770
Practice Address - Fax:614-451-2291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004829207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0752672Medicaid
OH0752672Medicaid