Provider Demographics
NPI:1023001500
Name:LANE, ROBERT EARL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
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 650
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944-0650
Mailing Address - Country:US
Mailing Address - Phone:252-426-5711
Mailing Address - Fax:252-426-1999
Practice Address - Street 1:600 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:HERTFORD
Practice Address - State:NC
Practice Address - Zip Code:27944-1205
Practice Address - Country:US
Practice Address - Phone:252-426-5711
Practice Address - Fax:252-426-1999
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18327207Q00000X
LAMD010642207Q00000X
SC21380207Q00000X
VA0101046348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
78190OtherMEDCOST
10839OtherCIGNA
239694OtherOPTIMUM CHOICE
239694OtherALLIANCE
012678OtherUNITED HEALTHCARE
339694OtherMAMSI
156394OtherTRIGON
50785OtherBLUE CROSS BLUE SHIELD
NC89-50785Medicaid
239694OtherOPTIMUM CHOICE
201407GMedicare ID - Type Unspecified