Provider Demographics
NPI:1962112250
Name:LANE, KELECHI JAMES
Entity type:Individual
Prefix:
First Name:KELECHI
Middle Name:JAMES
Last Name:LANE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 COWSILL DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1081
Mailing Address - Country:US
Mailing Address - Phone:202-487-3317
Mailing Address - Fax:
Practice Address - Street 1:6120 GEORGIA AVE NW APT 110
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5169
Practice Address - Country:US
Practice Address - Phone:202-487-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant