Individual
DR. JONATHAN M LENZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, FCCP
Contact information
Practice address
2210 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 575-5864
(434) 575-8929
Mailing address
2210 WILBORN AVE, SOUTH BOSTON, VA 24592-1630
(434) 575-5864
(434) 575-8929
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
0101048561
VA
207RP1001X
Pulmonary Disease Physician
0101048561
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006013996
—
VA
01
—
032464
ANTHEM BC PROVIDER #
VA
01
—
2317122
MEDICARE-GROUP #
NC
01
—
51700
BC/BS NC PROVIDER #
NC
05
—
890595Y
—
NC
Enumeration date
03/17/2006
Last updated
01/04/2008
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