Provider Demographics
NPI:1720098619
Name:JOHN LANE OBSTETRICS AND GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:JOHN LANE OBSTETRICS AND GYNECOLOGY PLLC
Other - Org Name:JOHN LANE OBGYN
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:AIDEN
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-235-3366
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:919-235-3366
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:919-235-3366
Practice Address - Fax:919-235-3367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902756Medicaid
NC5902756Medicaid