Provider Demographics
NPI:1356866800
Name:METZMAKER, MICHAEL NATHAN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:NATHAN
Last Name:METZMAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1705
Mailing Address - Country:US
Mailing Address - Phone:774-696-2254
Mailing Address - Fax:
Practice Address - Street 1:36 1ST AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02129-4557
Practice Address - Country:US
Practice Address - Phone:617-724-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-06
Last Update Date:2017-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant