Healthcare Provider Details

I. General information

NPI: 1336325612
Provider Name (Legal Business Name): CRAIG S. TENZER, M.D., D.P.M., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 MAIN ST
CHARLESTOWN MA
02129-3225
US

IV. Provider business mailing address

175 MAIN ST
CHARLESTOWN MA
02129-3225
US

V. Phone/Fax

Practice location:
  • Phone: 617-242-3344
  • Fax: 781-388-7086
Mailing address:
  • Phone: 617-242-3344
  • Fax: 781-388-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPD 1980
License Number StateMA

VIII. Authorized Official

Name: DR. CRAIG STEWART TENZER
Title or Position: OWNER
Credential: MD, DPM
Phone: 617-242-3344