Provider Demographics
NPI:1275523177
Name:LANE, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2301 REXWOODS DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-3366
Mailing Address - Country:US
Mailing Address - Phone:919-235-3369
Mailing Address - Fax:919-235-3367
Practice Address - Street 1:2301 REXWOODS DR
Practice Address - Street 2:SUITE 114
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3366
Practice Address - Country:US
Practice Address - Phone:919-235-3369
Practice Address - Fax:919-235-3367
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-02-20
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Provider Licenses
StateLicense IDTaxonomies
NC200500715207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC367000Medicare UPIN