Provider Demographics
NPI:1215954664
Name:LANCE, EDWARD D (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:D
Last Name:LANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2929 CROUSE LN
Mailing Address - Street 2:STE E
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8317
Mailing Address - Country:US
Mailing Address - Phone:336-584-4440
Mailing Address - Fax:336-584-4404
Practice Address - Street 1:316 N GRAHAM HOPEDALE RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27217-2969
Practice Address - Country:US
Practice Address - Phone:336-538-1234
Practice Address - Fax:336-584-6811
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8950676Medicaid
NC208063GMedicare ID - Type Unspecified
NCC85045Medicare UPIN