Individual
REBECCA T. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104
(215) 590-6336
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-6336
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
4301107078
MI
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
MT215011
PA
Other
Enumeration date
05/06/2015
Last updated
06/20/2018
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