Provider Demographics
NPI:1801901095
Name:LEHRMAN, JERROLD C (MD)
Entity type:Individual
Prefix:
First Name:JERROLD
Middle Name:C
Last Name:LEHRMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JERROLD
Other - Middle Name:C
Other - Last Name:LEHRMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:546 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6600
Mailing Address - Country:US
Mailing Address - Phone:203-634-0055
Mailing Address - Fax:203-639-0722
Practice Address - Street 1:546 S BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6600
Practice Address - Country:US
Practice Address - Phone:203-634-0055
Practice Address - Fax:203-639-0722
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT013781207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83669Medicare UPIN