Provider Demographics
NPI:1477546224
Name:CARANDANG, ELIZARDO P (MD)
Entity Type:Individual
Prefix:
First Name:ELIZARDO
Middle Name:P
Last Name:CARANDANG
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 1:354 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1754
Mailing Address - Country:US
Mailing Address - Phone:978-687-2321
Mailing Address - Fax:978-722-7287
Practice Address - Street 1:354 MERRIMACK ST STE 1
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1755
Practice Address - Country:US
Practice Address - Phone:978-687-2321
Practice Address - Fax:978-722-7287
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52974208100000X
NH6895208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA715266OtherTHP
MA23582OtherFCHP
MA0003754OtherNHP
MA80714OtherHPHC
NH0102641Y0MA01OtherANTHEM
MA1483069001OtherCIGNA
MA4390633OtherAETNA
MAJ03232OtherBCBSMA
MA6177344Medicaid
MA715266OtherTHP
MA0003754OtherNHP
MA1483069001OtherCIGNA
MAJ03232OtherBCBSMA