Healthcare Provider Details

I. General information

NPI: 1912226150
Provider Name (Legal Business Name): ZACHARY PAUL LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 VEAZEY DR
BUTNER NC
27509-1668
US

IV. Provider business mailing address

300 VEAZEY DR
BUTNER NC
27509-1668
US

V. Phone/Fax

Practice location:
  • Phone: 919-764-2000
  • Fax: 919-966-2181
Mailing address:
  • Phone: 919-764-2000
  • Fax: 919-966-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number165878
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: