Basic Information
| Provider Information | |||||||||
| NPI: | 1528056272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | ALLAN | ||||||||
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| Credential: | MD, MPH & TM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1204 FENWICK DRIVE | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4342003656 | ||||||||
| FaxNumber: | 4342003650 | ||||||||
| Practice Location | |||||||||
| Address1: | 1971 UNIVERSITY BLVD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245022269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345822514 | ||||||||
| FaxNumber: | 4344550966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2005 | ||||||||
| LastUpdateDate: | 11/15/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 01011043860 | VA | N | Other Service Providers | Specialist | 207Q00000X | 0101043860 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 005623308 | 05 | VA | MEDICAID |