Individual
DR. DAVID RICHEY LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15830 BALLANTYNE MEDICAL PLACE, STE 225, CHARLOTTE, NC 28277-3294
(704) 919-1105
(704) 910-3163
Mailing address
15830 BALLANTYNE MEDICAL PLACE, STE 225, CHARLOTTE, NC 28277-3294
(704) 919-1105
(704) 910-3163
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
200600844
NC
207N00000X
Dermatology Physician
00844
NC
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
00844
NC
207NS0135X
Procedural Dermatology Physician
00844
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2075624
MEDICARE GROUP PTAN
NC
Enumeration date
07/02/2006
Last updated
05/08/2017
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