Provider Demographics
NPI:1528056272
Name:LANE, RICHARD ALLAN (MD, MPH & TM)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLAN
Last Name:LANE
Suffix:
Gender:M
Credentials:MD, MPH & TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 FENWICK DRIVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2112
Mailing Address - Country:US
Mailing Address - Phone:434-200-3656
Mailing Address - Fax:434-200-3650
Practice Address - Street 1:1971 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2269
Practice Address - Country:US
Practice Address - Phone:434-582-2514
Practice Address - Fax:434-455-0966
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01011043860174400000X
VA0101043860207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005623308Medicaid
VA080004110Medicare ID - Type Unspecified
VAE14098Medicare UPIN