Healthcare Provider Details

I. General information

NPI: 1548253198
Provider Name (Legal Business Name): CHARLOTTE L METZLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4407 FAIRMOUNT AVE
PORT ANGELES WA
98363-9514
US

IV. Provider business mailing address

4407 FAIRMOUNT AVE
PORT ANGELES WA
98363-9514
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-0760
  • Fax: 360-457-0920
Mailing address:
  • Phone: 360-457-0760
  • Fax: 360-457-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD00027749
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberMD00027749
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: