Provider Demographics
NPI:1962838607
Name:KANE, BETHANY ELYSE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:ELYSE
Last Name:KANE
Suffix:
Gender:F
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:PO BOX 1409
Mailing Address - Street 2:26840 POINT LOOKOUT ROAD
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-1409
Mailing Address - Country:US
Mailing Address - Phone:301-475-8091
Mailing Address - Fax:301-475-6712
Practice Address - Street 1:3445 BOX HILL CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1223
Practice Address - Country:US
Practice Address - Phone:410-569-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005150363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical