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NPI Code Detail

MEDICARE: MR. EDWARD A LANEAR PA-C

MEDICARE: MR. EDWARD A LANEAR PA-C
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
1363AM0700XMedical Physician Assistant101385NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1970002946OTHERNCRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2101385OTHERNCLICENSE NUMBER

General Provider Information

NPI Number : 1407805609
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDWARD A LANEAR PA-C
Provider Business Mailing Address
First Line : PO BOX 7200
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-0200
Country : US
Telephone Number : 252-937-0200
Fax Number : 252-451-0056
Provider Business Practice Location Address
First Line : 921 N WINSTEAD AVE
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27804-8749
Country : US
Telephone Number : 252-937-0300
Fax Number : 252-937-3108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2006
Last Update Date : 03/30/2015

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