Provider Demographics
NPI:1255627204
Name:METANCHUK, THERESA RENEE (DO)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:RENEE
Last Name:METANCHUK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:RENEE
Other - Last Name:HIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:455 WOODVIEW RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-9303
Mailing Address - Country:US
Mailing Address - Phone:610-345-1900
Mailing Address - Fax:610-345-1901
Practice Address - Street 1:455 WOODVIEW RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-9303
Practice Address - Country:US
Practice Address - Phone:610-345-1900
Practice Address - Fax:610-345-1901
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine