Provider Demographics
NPI:1770570426
Name:LANE, LEO WILLIAM (DO)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:WILLIAM
Last Name:LANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:421 MERRIMACK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5803
Mailing Address - Country:US
Mailing Address - Phone:978-725-4822
Mailing Address - Fax:978-725-5277
Practice Address - Street 1:421 MERRIMACK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5803
Practice Address - Country:US
Practice Address - Phone:978-725-4822
Practice Address - Fax:978-725-5277
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA155341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0400810YPMA01OtherANTHEM BCBS
MA2301962OtherAETNA US HEALTH
MAJ21428OtherBCBS MA
MA3208621Medicaid
MA49241OtherFALLON
MA50493OtherMATTHEW THORNTON
MA043549868OtherUNITED HEALTH
MA504290OtherCIGNA HEALTHSOURCE
MA504290OtherHEALTH SOURCE
MA69499OtherHARVARD PILGRIM
MA043549868OtherHCVM
MA043549868OtherPHCS
MA155341OtherTUFTS
MA2301962OtherUS HEALTH
MA9593735010OtherCIGNA
MAA29725Medicare ID - Type Unspecified
MA3208621Medicaid