Provider Demographics
NPI:1669853271
Name:MCLANE, MICHAEL
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:MCLANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 BLAKESLEE BOULEVARD DR E STE 3
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-2401
Mailing Address - Country:US
Mailing Address - Phone:570-645-1020
Mailing Address - Fax:570-645-1021
Practice Address - Street 1:1241 BLAKESLEE BOULEVARD DR E STE 3
Practice Address - Street 2:
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-2401
Practice Address - Country:US
Practice Address - Phone:570-645-1020
Practice Address - Fax:570-645-1021
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016362207R00000X
PAOS021324207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine