Healthcare Provider Details

I. General information

NPI: 1134147101
Provider Name (Legal Business Name): HERBERT EDWARD LANE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: H EDWARD LANE III MD

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8180 GREENSBORO DR STE 300
MC LEAN VA
22102-3888
US

IV. Provider business mailing address

PO BOX 75868
BALTIMORE MD
21275-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5217
  • Fax: 703-810-5423
Mailing address:
  • Phone: 703-383-6469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101035337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: