Provider Demographics
NPI:1851779573
Name:NEIDIG, LANE (MD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:NEIDIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2568A RIVA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7457
Mailing Address - Country:US
Mailing Address - Phone:410-216-0993
Mailing Address - Fax:410-237-6106
Practice Address - Street 1:2568A RIVA RD STE 102
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7457
Practice Address - Country:US
Practice Address - Phone:410-216-0993
Practice Address - Fax:410-237-6106
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0087259207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology