Provider Demographics
NPI:1982683058
Name:LEBOWITZ, CHARLES (MD)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:LEBOWITZ
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 1:3242 COVE BEND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2752
Mailing Address - Country:US
Mailing Address - Phone:813-978-1100
Mailing Address - Fax:813-978-1120
Practice Address - Street 1:3242 COVE BEND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2752
Practice Address - Country:US
Practice Address - Phone:813-978-1100
Practice Address - Fax:813-978-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 46024207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40557Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLD56656Medicare UPIN