Provider Demographics
NPI:1760747026
Name:LEHMANN, GLORIA CHANSONG (MD)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:CHANSONG
Last Name:LEHMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:CHANSONG
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1465 S GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-1003
Mailing Address - Country:US
Mailing Address - Phone:314-577-5380
Mailing Address - Fax:314-268-4141
Practice Address - Street 1:1465 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-577-5380
Practice Address - Fax:314-268-4141
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20150186192080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology