Provider Demographics
NPI:1508835448
Name:METELKA, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:METELKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BMH PHYSICIANS OFFICE BUILDING
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-1527
Mailing Address - Country:US
Mailing Address - Phone:865-546-1642
Mailing Address - Fax:865-681-7949
Practice Address - Street 1:270 BMH PHYSICIANS OFFICE BUILDING
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-3780
Practice Address - Country:US
Practice Address - Phone:865-546-1642
Practice Address - Fax:865-681-7949
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13537207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007727Medicaid
TN6169073OtherBCBS
TN3006823Medicaid