Organization
EDWARD M LANE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. IZAMARI GARCIA (MANAGER)
(203) 372-0009
Entity
Organization
Contact information
Practice address
4675 MAIN ST, BRIDGEPORT, CT 06606-1813
(203) 372-0009
(203) 372-7931
Mailing address
4675 MAIN ST, BRIDGEPORT, CT 06606-1813
(203) 372-0009
(203) 372-7931
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
024203
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001242031
—
CT
01
—
1033140876
INDIVIDUAL NPI
CT
01
—
1700063013
ORGANIZATIONAL NPI
CT
Enumeration date
01/29/2008
Last updated
05/13/2013
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