Provider Demographics
NPI:1891135786
Name:LANE, CHARLES DARRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:DARRELL
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:C.
Other - Middle Name:DARRELL
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2 DOGWOOD VLY
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-7445
Mailing Address - Country:US
Mailing Address - Phone:717-625-4828
Mailing Address - Fax:
Practice Address - Street 1:2 DOGWOOD VLY
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7445
Practice Address - Country:US
Practice Address - Phone:717-625-4828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-25
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-008392-E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology