Healthcare Provider Details

I. General information

NPI: 1568407757
Provider Name (Legal Business Name): METRO PHYSICIANS SPECIALTY GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BALA PLZ STE PL20
BALA CYNWYD PA
19004-1507
US

IV. Provider business mailing address

PO BOX 14
BALA CYNWYD PA
19004-9998
US

V. Phone/Fax

Practice location:
  • Phone: 610-451-2800
  • Fax: 610-660-0360
Mailing address:
  • Phone: 610-451-2800
  • Fax: 610-660-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN PERRY
Title or Position: AO
Credential:
Phone: 267-249-1745