MEDICARE: MARKLANE, LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	0701002355	VA

General Provider Information

NPI Number	:	1770640765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARKLANE, LTD.

Provider Business Mailing Address
First Line	:	8401 PATTERSON AVE
Second Line	:	SUITE G-102
City	:	RICHMOND
State	:	VA
Zip	:	23229-6430
Country	:	US
Telephone Number	:	804-740-1829
Fax Number	:

Provider Business Practice Location Address
First Line	:	8401 PATTERSON AVE
Second Line	:	SUITE G-102
City	:	RICHMOND
State	:	VA
Zip	:	23229-6430
Country	:	US
Telephone Number	:	804-740-1829
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK RICHARD LANE
Credential	:	D.MIN.
Telephone Number	:	804-740-1829

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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