Provider Demographics
NPI:1093432528
Name:PIERCE, ETHAN CHARLES (PA-C)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:CHARLES
Last Name:PIERCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 SKYLYN DR STE 410
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1081
Mailing Address - Country:US
Mailing Address - Phone:864-585-4263
Mailing Address - Fax:
Practice Address - Street 1:1650 SKYLYN DR STE 410
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1081
Practice Address - Country:US
Practice Address - Phone:864-585-4263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMPA.4664.PA2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand