Provider Demographics
NPI:1316925167
Name:DAVLIN, LANCE (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:DAVLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 KEMPSVILLE RD STE 104
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3927
Mailing Address - Country:US
Mailing Address - Phone:757-252-5600
Mailing Address - Fax:757-226-0157
Practice Address - Street 1:844 KEMPSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3927
Practice Address - Country:US
Practice Address - Phone:757-252-5600
Practice Address - Fax:757-226-0157
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046122207XS0106X
VA046122207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
400000649OtherRAILROAD MEDICARE
CC7688OtherRAILROAD MEDICARE GROUP#
VA006405771Medicaid
C00102OtherMEDICARE GROUP LEGACY NUM
F82883Medicare UPIN
400000015Medicare PIN