Provider Demographics
NPI:1861427916
Name:LANE, CHRISTIAN HORTON (RTR,RCS)
Entity type:Individual
Prefix:MRS
First Name:CHRISTIAN
Middle Name:HORTON
Last Name:LANE
Suffix:
Gender:F
Credentials:RTR,RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:CHADBOURN
Mailing Address - State:NC
Mailing Address - Zip Code:28431-0434
Mailing Address - Country:US
Mailing Address - Phone:910-914-6154
Mailing Address - Fax:910-914-6156
Practice Address - Street 1:136 MEMORY PLZ
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-2640
Practice Address - Country:US
Practice Address - Phone:910-654-4789
Practice Address - Fax:910-654-6939
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1126252085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8105016Medicaid
NC13952OtherBCBS OF NC
NC2881779Medicare PIN