Provider Demographics
NPI:1891986535
Name:CLYDE C METZGER, MD
Entity Type:Organization
Organization Name:CLYDE C METZGER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:C
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-266-6774
Mailing Address - Street 1:PO BOX 994
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-5994
Mailing Address - Country:US
Mailing Address - Phone:740-282-2576
Mailing Address - Fax:740-282-2239
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:SUITE 206
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2356
Practice Address - Country:US
Practice Address - Phone:740-266-6774
Practice Address - Fax:740-266-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35031444M207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0118205Medicaid
OHDB0445OtherRAILROAD MEDICARE
OHA71413Medicare UPIN
OHSP05103Medicare PIN