MEDICARE: CHARLES WOOLLEY LEHNARDT DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	OS20618	FL
2	207Q00000X	Family Medicine Physician	262156	MA
3	207Q00000X	Family Medicine Physician	OS20618	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12320823	OTHER		CAQH

General Provider Information

NPI Number	:	1487811329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES WOOLLEY LEHNARDT DO

Provider Business Mailing Address
First Line	:	7975 LAKE UNDERHILL RD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8204
Country	:	US
Telephone Number	:	407-303-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	7975 LAKE UNDERHILL RD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-8204
Country	:	US
Telephone Number	:	407-303-6830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	09/06/2024

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