Healthcare Provider Details

I. General information

NPI: 1912967076
Provider Name (Legal Business Name): C. WAYNE LANKFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 TAYLOR RD
CHESAPEAKE VA
23321
US

IV. Provider business mailing address

PO BOX 758963
BALTIMORE MD
21275-8963
US

V. Phone/Fax

Practice location:
  • Phone: 757-215-1800
  • Fax:
Mailing address:
  • Phone: 804-968-5700
  • Fax: 804-217-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: