Individual
LANE M LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
400 MATTHEW ST STE 401, MARIETTA, OH 45750-1656
(740) 374-2252
(740) 374-4974
Mailing address
PO BOX 449, MARIETTA, OH 45750-0449
(740) 374-4500
(740) 374-5887
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
7886
ND
2086S0129X
Vascular Surgery Physician
Primary
34.005124
OH
2086S0129X
Vascular Surgery Physician
7886
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0827289
—
OH
05
—
10519
—
ND
05
—
3910000637
—
WV
01
—
P01297083
RAILROAD MEDICARE - MHCPI
OH
Enumeration date
10/10/2006
Last updated
01/11/2018
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