Provider Demographics
NPI:1669654729
Name:CORPORATION LANE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:CORPORATION LANE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-518-8823
Mailing Address - Street 1:4460 CORPORATION LN STE 190
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3150
Mailing Address - Country:US
Mailing Address - Phone:757-518-8823
Mailing Address - Fax:757-518-8832
Practice Address - Street 1:4460 CORPORATION LN STE 190
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3150
Practice Address - Country:US
Practice Address - Phone:757-518-8823
Practice Address - Fax:757-518-8832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V591K22Medicare PIN