MEDICARE: DR. DARII ANN LANE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD28665	SC
2	207Q00000X	Family Medicine Physician	0101251019	VA

General Provider Information

NPI Number	:	1184610701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARII ANN LANE MD

Provider Business Mailing Address
First Line	:	10010 ROGERS XING
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4673
Country	:	US
Telephone Number	:	210-539-0905
Fax Number	:	210-521-2574

Provider Business Practice Location Address
First Line	:	576 JEFFERSON AVE
Second Line	:
City	:	FT EUSTIS
State	:	VA
Zip	:	23604
Country	:	US
Telephone Number	:	757-314-7500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	11/20/2015

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