Doctor Name: | DR. HENDERSON MICHAEL LANE |
NPI Number: | 1821181157 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 14222 |
Business Practice Address: | 4500 Stuart St Moncrief Army Community Hospital/credentials Columbia, SC - 292075700 |
Business Phone Number: | 8037512618 |
Business Fax Number: | 8037512689 |
Mailing Address: | 4500 Stuart St, Moncrief Army Hospital, Attn: Mcxl-pq (credentials) COLUMBIA |
State: | SC |
Postal Code: | 292075700 |
Phone Number: | 8037512618 |
Fax Number: | 8037512689 |
NPI Enumeration Date: | 09/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 14222 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |