Provider Demographics
NPI:1386646263
Name:METRO PROSTHETICS, INC.
Entity Type:Organization
Organization Name:METRO PROSTHETICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLER
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:301-459-0999
Mailing Address - Street 1:7438 ANNAPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2314
Mailing Address - Country:US
Mailing Address - Phone:301-459-0999
Mailing Address - Fax:301-731-4308
Practice Address - Street 1:7438 ANNAPOLIS RD
Practice Address - Street 2:
Practice Address - City:LANDOVER HILLS
Practice Address - State:MD
Practice Address - Zip Code:20784-2314
Practice Address - Country:US
Practice Address - Phone:301-459-0999
Practice Address - Fax:301-731-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0708780Medicaid
MD0260670001Medicare ID - Type Unspecified