Provider Demographics
NPI:1790759199
Name:ZANE, EDWARD A (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:ZANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 488
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-0488
Mailing Address - Country:US
Mailing Address - Phone:860-355-9950
Mailing Address - Fax:860-350-9510
Practice Address - Street 1:21 ELM ST
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2915
Practice Address - Country:US
Practice Address - Phone:860-355-9950
Practice Address - Fax:860-350-9510
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028907207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1289075Medicaid
CTD97155Medicare UPIN
CT1289075Medicaid