Individual
CHARLES J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
180 FLOYD AVE, ROCKY MOUNT, VA 24151-1318
(540) 483-5277
Mailing address
PO BOX 2080, KILMARNOCK, VA 22482-2080
(804) 435-3508
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101054874
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005878357
—
VA
05
—
005878365
—
VA
Enumeration date
04/27/2006
Last updated
05/20/2008
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