Provider Demographics
NPI:1831171719
Name:LANE, INGVILD GANGSAAS (MD)
Entity type:Individual
Prefix:DR
First Name:INGVILD
Middle Name:GANGSAAS
Last Name:LANE
Suffix:
Gender:F
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 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-454-6780
Practice Address - Street 1:1020 29TH ST
Practice Address - Street 2:SUITE 480
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5125
Practice Address - Country:US
Practice Address - Phone:916-733-3777
Practice Address - Fax:916-454-6780
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53026207R00000X
WAMD00039957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0161861OtherLABOR & INDUSTRIES
WA8350332Medicaid
WAH62175Medicare UPIN
WA8350332Medicaid
WAAB29310Medicare ID - Type Unspecified