Provider Demographics
NPI:1295703692
Name:METCALFE, ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:METCALFE
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 1:10422 CARMEL CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:OAKDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95361-8921
Mailing Address - Country:US
Mailing Address - Phone:209-840-4094
Mailing Address - Fax:209-844-0309
Practice Address - Street 1:1330 NELSON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5341
Practice Address - Country:US
Practice Address - Phone:209-846-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2016-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65690207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0089790Medicaid
CA00A656900Medicare PIN
CAGR0089790Medicaid
CABS513ZMedicare PIN