1295792992 NPI number — LISA GABRIEL LANE PA

Table of content: MR. MARK (TE-HSIN) KAO OT (NPI 1063722742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295792992 NPI number — LISA GABRIEL LANE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
LISA
Provider Middle Name:
GABRIEL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295792992
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 MARKET STREET, STE 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27516
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-969-9611
Provider Business Mailing Address Fax Number:
919-969-9611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 MARKET STREET, STE 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-969-9611
Provider Business Practice Location Address Fax Number:
919-969-9615
Provider Enumeration Date:
04/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  515 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57183 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP0278 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "TRICARE CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4142200 . This is a "MVP HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44944 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8300399 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 042472266 . This is a "THREE RIVERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 44944 . This is a "CHILDRENS MED SECURITY" identifier . This identifiers is of the category "OTHER".




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