Provider Demographics
NPI:1396709879
Name:LENNEN, WILLIAM C (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LENNEN
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1431
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-703-5101
Practice Address - Street 1:759 S MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1156
Practice Address - Country:US
Practice Address - Phone:540-459-1383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME135530207X00000X
VA0101048438207X00000X
MDD0043129207X00000X
DCMD20100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2127576OtherALLIANCE PPO
DC3431-0005OtherCAREFIRST BCBS
VA010149363Medicaid
FL024222600Medicaid
VA144155OtherANTHEM BCBS
VA144155OtherANTHEM BCBS
VA14227N73Medicare ID - Type Unspecified
DC3431-0005OtherCAREFIRST BCBS
VAG33504Medicare UPIN
VA010149363Medicaid
00X683C03Medicare PIN