Healthcare Provider Details

I. General information

NPI: 1073454740
Provider Name (Legal Business Name): MADELINE PAIGE METZLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 NASON DR
ROARING SPRING PA
16673-1202
US

IV. Provider business mailing address

1970 COVE LANE RD
MARTINSBURG PA
16662-8712
US

V. Phone/Fax

Practice location:
  • Phone: 814-224-6235
  • Fax:
Mailing address:
  • Phone: 814-934-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA067818
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA007747
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: