Individual
DR. LACO LANE MACE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
327 MEDICAL PARK DR, BRIDGEPORT, WV 26330-9006
(681) 342-1000
Mailing address
PO BOX 763, MORGANTOWN, WV 26507-0763
(800) 541-4009
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036122070
IL
207R00000X
Internal Medicine Physician
26152
WV
208M00000X
Hospitalist Physician
Primary
26152
WV
Other
Enumeration date
11/05/2007
Last updated
04/05/2022
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