Provider Demographics
NPI:1770508293
Name:LANE, AARON BRICE (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:BRICE
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:4TH & WILLOW STREET
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-0300
Mailing Address - Country:US
Mailing Address - Phone:717-272-4190
Mailing Address - Fax:717-675-2743
Practice Address - Street 1:30 N 4TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-5606
Practice Address - Country:US
Practice Address - Phone:717-274-0474
Practice Address - Fax:717-274-0673
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426749207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101339107Medicaid
I37086Medicare UPIN
093349PUDMedicare ID - Type Unspecified