Provider Demographics
NPI:1588092662
Name:METZ, TODD JEREMY (NP)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JEREMY
Last Name:METZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 COURTENAY DR STE 3053
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29425-8911
Mailing Address - Country:US
Mailing Address - Phone:438-765-9698
Mailing Address - Fax:
Practice Address - Street 1:25 COURTENAY DR STE 3053
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29425-8911
Practice Address - Country:US
Practice Address - Phone:438-765-9698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18540363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2683Medicaid