Provider Demographics
NPI:1407805609
Name:LANEAR, EDWARD A (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:LANEAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:921 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8749
Practice Address - Country:US
Practice Address - Phone:252-937-0300
Practice Address - Fax:252-937-3108
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101385363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC970002946OtherRAILROAD MEDICARE
NC101385OtherLICENSE NUMBER
NC970002946OtherRAILROAD MEDICARE
NCS65785Medicare UPIN