Healthcare Provider Details

I. General information

NPI: 1265394811
Provider Name (Legal Business Name): JESSICA METZGAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 7TH AVE
ALTOONA PA
16602-2402
US

IV. Provider business mailing address

2117 16TH AVE
ALTOONA PA
16601-2340
US

V. Phone/Fax

Practice location:
  • Phone: 814-944-8784
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberSP034671
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: