Provider Demographics
NPI:1033105291
Name:LANE, MARY BOGGS (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BOGGS
Last Name:LANE
Suffix:
Gender:F
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:CHEROKEE COUNTY HEALTH DEPARTMENT
Mailing Address - Street 2:228 HILTON STREET
Mailing Address - City:MURPHY
Mailing Address - State:NC
Mailing Address - Zip Code:28906-2814
Mailing Address - Country:US
Mailing Address - Phone:828-837-7486
Mailing Address - Fax:828-835-7854
Practice Address - Street 1:CHEROKEE COUNTY HEALTH DEPARTMENT
Practice Address - Street 2:228 HILTON STREET
Practice Address - City:MURPHY
Practice Address - State:NC
Practice Address - Zip Code:28906-2814
Practice Address - Country:US
Practice Address - Phone:828-837-7486
Practice Address - Fax:828-835-7854
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32508207Q00000X, 207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890288NMedicaid
NC2324429Medicare PIN
NC890288NMedicaid