Healthcare Provider Details

I. General information

NPI: 1528056272
Provider Name (Legal Business Name): RICHARD ALLAN LANE MD, MPH & TM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 11/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1971 UNIVERSITY BLVD
LYNCHBURG VA
24502-2269
US

IV. Provider business mailing address

1204 FENWICK DRIVE
LYNCHBURG VA
24502-2112
US

V. Phone/Fax

Practice location:
  • Phone: 434-582-2514
  • Fax: 434-455-0966
Mailing address:
  • Phone: 434-200-3656
  • Fax: 434-200-3650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01011043860
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101043860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: