Provider Demographics
NPI:1336325612
Name:CRAIG S. TENZER, M.D., D.P.M., P.C.
Entity Type:Organization
Organization Name:CRAIG S. TENZER, M.D., D.P.M., P.C.
Other - Org Name:FOOTMED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEWART
Authorized Official - Last Name:TENZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DPM
Authorized Official - Phone:617-242-3344
Mailing Address - Street 1:175 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3225
Mailing Address - Country:US
Mailing Address - Phone:617-242-3344
Mailing Address - Fax:781-388-7086
Practice Address - Street 1:175 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:MA
Practice Address - Zip Code:02129-3225
Practice Address - Country:US
Practice Address - Phone:617-242-3344
Practice Address - Fax:781-388-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD 1980213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAU34024Medicare UPIN
MA0003832Medicare PIN
MA000383201Medicare PIN
MA0781330001Medicare NSC