Healthcare Provider Details

I. General information

NPI: 1336192145
Provider Name (Legal Business Name): RICHARD LANE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 BLEAK HOUSE RD
EARLYSVILLE VA
22936-2206
US

IV. Provider business mailing address

PO BOX 630088
HIGHLANDS RANCH CO
80163-0088
US

V. Phone/Fax

Practice location:
  • Phone: 434-906-1982
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101239372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: