Provider Demographics
NPI:1366474843
Name:METCHO, JUSTINE M (DPM)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:M
Last Name:METCHO
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Gender:F
Credentials:DPM
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Mailing Address - Street 1:532 MAIN ST
Mailing Address - Street 2:SUITE #2
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1001
Mailing Address - Country:US
Mailing Address - Phone:570-457-6540
Mailing Address - Fax:570-457-6541
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:SUITE #2
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1001
Practice Address - Country:US
Practice Address - Phone:570-457-6540
Practice Address - Fax:570-457-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2016-04-04
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Provider Licenses
StateLicense IDTaxonomies
PASC004803L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA86860OtherGEISINGER HEALTH PLAN
PA074462OtherRAILROAD MEDICARE
PA3504465OtherAETNA HEALTH PLANS HMO
PA1009955070005Medicaid
PA1620344OtherBLUE SHIELD PA
PA163916OtherUNISON
PA7715557OtherAETNA HEALTH PLANS PPO 7715557
PA818157OtherFIRST PRIORITY HEALTH
PA818157OtherFIRST PRIORITY HEALTH
PA3504465OtherAETNA HEALTH PLANS HMO