Provider Demographics
NPI:1548440860
Name:LERNER, CHARLES EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDWARD
Last Name:LERNER
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 1:7259 S BINGHAM JUNCTION BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-4860
Mailing Address - Country:US
Mailing Address - Phone:800-453-3030
Mailing Address - Fax:
Practice Address - Street 1:181 FRANKLIN HEALTH CMNS
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6144
Practice Address - Country:US
Practice Address - Phone:207-778-4922
Practice Address - Fax:207-779-0649
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07865207R00000X
ALMD35021207R00000X
FLME101456207R00000X
MEMD19073207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3311WMedicare PIN
FL000689200Medicaid