Provider Demographics
NPI:1043292345
Name:LANCE, ERIC D (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:LANCE
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:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-3346
Mailing Address - Fax:
Practice Address - Street 1:1219 LEXINGTON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2870
Practice Address - Country:US
Practice Address - Phone:336-475-7148
Practice Address - Fax:336-475-7031
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137J6OtherNC BCBS PROVIDER #
NC89137J6Medicaid
NC137J6OtherNC BCBS PROVIDER #
NCNC3293AMedicare PIN