Provider Demographics
NPI:1881700342
Name:LANE, EDWARD J (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:LANE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7901 DILEY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110
Mailing Address - Country:US
Mailing Address - Phone:614-835-3838
Mailing Address - Fax:614-834-4750
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110
Practice Address - Country:US
Practice Address - Phone:614-835-3838
Practice Address - Fax:614-834-4750
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-076899207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH598447Medicaid
OHH42591Medicare UPIN
OH598447Medicaid