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General NPI Number Information
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NPI Number | 1720169998
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Entity Type | Individual
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Provider Name | WHITNEY L LANE MD
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 4525 CAMERON VALLEY PKWY SUITE 2100
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City | CHARLOTTE
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State | NC
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Zip | 28211-4369
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Country | US
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Telephone | 704-302-8350
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Fax | 704-302-8351
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Provider Business Mailing Address
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Address Line | PO BOX 601643
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City | CHARLOTTE
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State | NC
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Zip | 28260-1643
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Country | US
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Telephone | 704-302-8350
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Fax | 704-302-8351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2006-01591
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License Number State | NC
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