Provider Demographics
NPI:1598024093
Name:PAYNE, ETHAN (MD)
Entity Type:Individual
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First Name:ETHAN
Middle Name:
Last Name:PAYNE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:300 PLAZA CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-8260
Mailing Address - Country:US
Mailing Address - Phone:570-421-8842
Mailing Address - Fax:570-476-5842
Practice Address - Street 1:300 PLAZA CT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-8260
Practice Address - Country:US
Practice Address - Phone:570-421-8842
Practice Address - Fax:570-476-5842
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2016-08-12
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Provider Licenses
StateLicense IDTaxonomies
PAMD457973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology