MEDICARE: CHARLOTTE L METZLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	MD00027749	WA
2	207NS0135X	Procedural Dermatology Physician	MD00027749	WA

General Provider Information

NPI Number	:	1548253198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLOTTE L METZLER MD

Provider Business Mailing Address
First Line	:	4407 FAIRMOUNT AVE
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-9514
Country	:	US
Telephone Number	:	360-457-0760
Fax Number	:	360-457-0920

Provider Business Practice Location Address
First Line	:	4407 FAIRMOUNT AVE
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98363-9514
Country	:	US
Telephone Number	:	360-457-0760
Fax Number	:	360-457-0920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	03/12/2008

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