Healthcare Provider Details

I. General information

NPI: 1205127859
Provider Name (Legal Business Name): STEPHEN M LANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 FITZHUGH AVE
RICHMOND VA
23226-1800
US

IV. Provider business mailing address

313 CHESWICK LN
HENRICO VA
23229-7661
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-5700
  • Fax:
Mailing address:
  • Phone: 804-396-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101253655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101253655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: