Provider Demographics
NPI:1346231453
Name:TENZER, CRAIG STEWART (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEWART
Last Name:TENZER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 CANNON FORGE DR
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-5212
Mailing Address - Country:US
Mailing Address - Phone:617-620-9758
Mailing Address - Fax:508-698-9950
Practice Address - Street 1:235 HANOVER ST
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5246
Practice Address - Country:US
Practice Address - Phone:617-620-9758
Practice Address - Fax:508-698-9950
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD 1980213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA043282327OtherTAX IDENTIFICATION NUMBER
MAY70957OtherBLUE CROSS & BLUE SHIELD
MAY70957OtherBLUE CROSS & BLUE SHIELD
MA043282327OtherTAX IDENTIFICATION NUMBER
MAY70957Medicare ID - Type Unspecified