Provider Demographics
NPI:1699983353
Name:LANE, CHARLES JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JOSEPH
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 603725
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3725
Mailing Address - Country:US
Mailing Address - Phone:828-575-2625
Mailing Address - Fax:828-350-2174
Practice Address - Street 1:2728 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2445
Practice Address - Country:US
Practice Address - Phone:434-385-8190
Practice Address - Fax:434-385-5873
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101244964207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699983353Medicaid
VA00Y142A01OtherMEDICARE PTAN