Provider Demographics
NPI:1649245812
Name:METZGER, EDWARD J JR (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:METZGER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:640 ELLICOTT ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1245
Mailing Address - Country:US
Mailing Address - Phone:716-893-1010
Mailing Address - Fax:716-893-1002
Practice Address - Street 1:40 LA RIVIERE DR STE 201
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-4344
Practice Address - Country:US
Practice Address - Phone:716-893-1010
Practice Address - Fax:716-893-1002
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2022-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF302895363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY599610Medicare UPIN