Provider Demographics
NPI:1912902297
Name:HANDWERKER, ELLIOTT (DPM)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:HANDWERKER
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 1:77 MORAGA WAY
Mailing Address - Street 2:STE H
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-3019
Mailing Address - Country:US
Mailing Address - Phone:925-254-5046
Mailing Address - Fax:925-254-5360
Practice Address - Street 1:77 MORAGA WAY
Practice Address - Street 2:STE H
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-3019
Practice Address - Country:US
Practice Address - Phone:925-254-5046
Practice Address - Fax:925-254-5360
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2040213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E20400Medicare PIN
CAT11149Medicare UPIN
CA0200410001Medicare NSC