Provider Demographics
NPI:1982290656
Name:FADALE, ETHAN (PA-C)
Entity type:Individual
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First Name:ETHAN
Middle Name:
Last Name:FADALE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2225 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4808
Mailing Address - Country:US
Mailing Address - Phone:570-898-9884
Mailing Address - Fax:
Practice Address - Street 1:1809 W OREGON AVE STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-3700
Practice Address - Country:US
Practice Address - Phone:215-389-3890
Practice Address - Fax:215-551-0368
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2025-07-30
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Provider Licenses
StateLicense IDTaxonomies
PAMA061845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant