Basic Information
Provider Information | |||||||||
NPI: | 1558629816 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LANE | ||||||||
FirstName: | MOLLIE | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 110 IRVING ST NW | ||||||||
Address2: | DEPT OF PULMONARY DISEASE/CRITICAL CARE MEDICINE | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200103017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2028777856 | ||||||||
FaxNumber: | 2028776130 | ||||||||
Practice Location | |||||||||
Address1: | 110 IRVING ST NW | ||||||||
Address2: | DEPT OF PULMONARY DISEASE/CRITICAL CARE MEDICINE | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200103017 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2028777856 | ||||||||
FaxNumber: | 2028776130 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/24/2012 | ||||||||
LastUpdateDate: | 08/16/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD043262 | DC | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 390200000X |   |   | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 207RP1001X | MD043262 | DC | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.