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General NPI Number Information
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NPI Number | 1366474843
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Entity Type | Individual
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Provider Name | JUSTINE M METCHO DPM
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Gender | Female
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 04/04/2016
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Provider Practice Location Address
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Address Line | 532 MAIN ST SUITE #2
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City | MOOSIC
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State | PA
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Zip | 18507-1001
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Country | US
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Telephone | 570-457-6540
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Fax | 570-457-6541
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Provider Business Mailing Address
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Address Line | 532 MAIN ST SUITE #2
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City | MOOSIC
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State | PA
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Zip | 18507-1001
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Country | US
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Telephone | 570-457-6540
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Fax | 570-457-6541
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC004803L
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License Number State | PA
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