Provider Demographics
NPI:1770566408
Name:LANE, GEORGE DOUGLAS (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DOUGLAS
Last Name:LANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W ANNANDALE RD
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4226
Mailing Address - Country:US
Mailing Address - Phone:703-237-3930
Mailing Address - Fax:703-649-4233
Practice Address - Street 1:510 W ANNANDALE RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4226
Practice Address - Country:US
Practice Address - Phone:703-237-3930
Practice Address - Fax:703-649-4233
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103001044213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9302719Medicaid
U79786Medicare UPIN
VA9302719Medicaid