Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD444241 | PA |
N | 207Q00000X | Family Doctor | MT196136 | PA |
NPI | 1003044934 |
---|---|
Provider Name | David Metzger |
First Address | Harrisburg, PA 17104-1612 |
Second Address | Harrisburg, PA 17101-2010 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 27/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102743080 | (05) | PA |