Provider Demographics
NPI:1477585297
Name:KARRENBERG, ELIZABETH ROMAC (DPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROMAC
Last Name:KARRENBERG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:ROMAC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:10 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-1893
Mailing Address - Country:US
Mailing Address - Phone:860-233-1978
Mailing Address - Fax:860-233-6812
Practice Address - Street 1:10 PRINCETON ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-1893
Practice Address - Country:US
Practice Address - Phone:860-233-1978
Practice Address - Fax:860-233-6812
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT565213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U19276Medicare UPIN