Healthcare Provider Details

I. General information

NPI: 1730382375
Provider Name (Legal Business Name): ELLEN METZGER MS, RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HEBRON AVE STE 107
GLASTONBURY CT
06033-2176
US

IV. Provider business mailing address

427 STANLEY DR
GLASTONBURY CT
06033-2623
US

V. Phone/Fax

Practice location:
  • Phone: 860-659-4656
  • Fax: 860-659-4656
Mailing address:
  • Phone: 860-659-8990
  • Fax: 860-659-4656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number000593
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: