Provider Demographics
NPI:1346207529
Name:LEHMAN, CHARLES HERMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HERMAN
Last Name:LEHMAN
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 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-2130
Mailing Address - Country:US
Mailing Address - Phone:970-542-0360
Mailing Address - Fax:970-542-0366
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2130
Practice Address - Country:US
Practice Address - Phone:970-542-0360
Practice Address - Fax:970-542-0366
Is Sole Proprietor?:No
Enumeration Date:2006-04-30
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01202167Medicaid
2133313Medicare ID - Type Unspecified
CO01202167Medicaid
D35773Medicare UPIN
COCO300454Medicare PIN