Provider Demographics
NPI:1740372358
Name:LANE, CRAIG R (DPM)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:R
Last Name:LANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N CAREY STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217
Mailing Address - Country:US
Mailing Address - Phone:410-523-5898
Mailing Address - Fax:410-523-5815
Practice Address - Street 1:911 N CAREY STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217
Practice Address - Country:US
Practice Address - Phone:410-523-5898
Practice Address - Fax:410-523-5815
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01178213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403809600Medicaid
MD403809600Medicaid
MDT375Medicare PIN