Provider Demographics
NPI:1316166630
Name:HANDWERKER, JASON (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:HANDWERKER
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 1:200 W ARBOR DR
Mailing Address - Street 2:MC 8749
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-8749
Mailing Address - Country:US
Mailing Address - Phone:619-543-6607
Mailing Address - Fax:619-471-0544
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8749
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-8749
Practice Address - Country:US
Practice Address - Phone:619-543-6607
Practice Address - Fax:619-471-0544
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1147042085N0700X
MA2316392085R0202X
CO477122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00809999Medicare PIN
COP00772606Medicare PIN
COCO305350Medicare PIN
COCO305351Medicare PIN