Provider Demographics
NPI:1013910199
Name:METZGER, STEVEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ALAN
Last Name:METZGER
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 1:406 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1803
Mailing Address - Country:US
Mailing Address - Phone:315-472-4701
Mailing Address - Fax:315-471-0411
Practice Address - Street 1:406 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1803
Practice Address - Country:US
Practice Address - Phone:315-472-4701
Practice Address - Fax:315-471-0411
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1093041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00465696Medicaid
NYB81213Medicare ID - Type Unspecified