Healthcare Provider Details

I. General information

NPI: 1376524314
Provider Name (Legal Business Name): JONATHAN P METZGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 TARKILN RD
KINGSTON MA
02364-1250
US

IV. Provider business mailing address

143 LONGWATER DR
NORWELL MA
02061-1683
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-2200
  • Fax: 781-585-1784
Mailing address:
  • Phone: 781-878-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number156683
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: