Healthcare Provider Details

I. General information

NPI: 1184074783
Provider Name (Legal Business Name): CHAD JORDAN METZGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LANSDOWNE AVE
DARBY PA
19023-1200
US

IV. Provider business mailing address

871 N JUDSON ST
PHILADELPHIA PA
19130-1936
US

V. Phone/Fax

Practice location:
  • Phone: 610-237-4000
  • Fax:
Mailing address:
  • Phone: 703-362-8135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberOT017076
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberOS020852
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: