Provider Demographics
NPI:1851377865
Name:LANE, WINSTON EARL III (MD)
Entity Type:Individual
Prefix:DR
First Name:WINSTON
Middle Name:EARL
Last Name:LANE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:502 RED BANKS RD STE A
Mailing Address - Street 2:P.O. BOX 20128
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5751
Mailing Address - Country:US
Mailing Address - Phone:252-758-4810
Mailing Address - Fax:252-758-3790
Practice Address - Street 1:502 RED BANKS RD STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5751
Practice Address - Country:US
Practice Address - Phone:252-758-4810
Practice Address - Fax:252-758-3790
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC315632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950799Medicaid
NC208078AMedicare ID - Type UnspecifiedMEDICARE
NC8950799Medicaid