Provider Demographics
NPI:1215920301
Name:LANE, JENNIFER MARY (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARY
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:91 MONTVALE AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3649
Mailing Address - Country:US
Mailing Address - Phone:781-306-6166
Mailing Address - Fax:781-418-1919
Practice Address - Street 1:91 MONTVALE AVE STE 208
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3649
Practice Address - Country:US
Practice Address - Phone:781-306-6166
Practice Address - Fax:781-418-1919
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-02-18
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Provider Licenses
StateLicense IDTaxonomies
MA247127208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery