Provider Demographics
NPI:1457450397
Name:METZGER, TIMOTHY P (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:P
Last Name:METZGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:512A CHURCH ST S
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:WV
Practice Address - Zip Code:25271-1616
Practice Address - Country:US
Practice Address - Phone:304-372-1033
Practice Address - Fax:304-373-0223
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV007593451OtherAETNA
WV001721672OtherBCBS
WV550737600Other25550
WV3810001232Medicaid
WV001721672OtherBCBS
OH4146082Medicare ID - Type UnspecifiedOHIO MEDICARE ID#
WV3810001232Medicaid