MEDICARE: RICHARD ALLAN LANE MD, MPH & TM

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	174400000X	Specialist	01011043860	VA
2	207Q00000X	Family Medicine Physician	0101043860	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528056272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD ALLAN LANE MD, MPH & TM

Provider Business Mailing Address
First Line	:	1204 FENWICK DRIVE
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2112
Country	:	US
Telephone Number	:	434-200-3656
Fax Number	:	434-200-3650

Provider Business Practice Location Address
First Line	:	1971 UNIVERSITY BLVD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-2269
Country	:	US
Telephone Number	:	434-582-2514
Fax Number	:	434-455-0966

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	11/15/2010

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