Provider Demographics
NPI:1750903746
Name:LANE, MARCUS (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 MIDDLE PARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-2243
Mailing Address - Country:US
Mailing Address - Phone:303-323-5844
Mailing Address - Fax:
Practice Address - Street 1:205 MIDDLE PARK DR
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-2243
Practice Address - Country:US
Practice Address - Phone:303-323-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant