Individual
DR. CHARLES EHLENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1350 HICKORY STREET, MELBOURNE, FL 32901-3224
(321) 434-7000
Mailing address
PO BOX 2400, MELBOURNE, FL 32902-2400
(321) 837-3820
(772) 621-3184
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MD431204
PA
2085R0202X
Diagnostic Radiology Physician
ME115600
FL
2085R0204X
Vascular & Interventional Radiology Physician
0101245945
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008591300
—
FL
01
—
14PS0
FLORIDA BLUE
FL
01
—
P01186454
RAILROAD MEDICARE
FL
Enumeration date
05/29/2007
Last updated
03/20/2026
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