Provider Demographics
NPI:1720062953
Name:LANE, MELANIE ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:ANN
Last Name:LANE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17014 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2479
Mailing Address - Country:US
Mailing Address - Phone:623-866-4484
Mailing Address - Fax:415-252-7176
Practice Address - Street 1:17014 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2479
Practice Address - Country:US
Practice Address - Phone:623-866-4484
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30590207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ30590OtherLICENSE
AZZ22506OtherMEDICARE GROUP PIN
AZZ22506OtherMEDICARE GROUP PIN
AZ30590OtherLICENSE
H57869Medicare UPIN