Clontz, Ethan Brody

Clontz, Ethan Brody is an individual health care provider with primary practice located at 171 Ashley Ave , Charleston SC 29425-6483. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Clontz, Ethan Brody can be contacted via phone (843) 792-1414.

Contact Information

Primary practice address
171 Ashley Ave Charleston SC 29425-6483
Phone: (843) 792-1414
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 3574 South Carolina

Profile Details

NPI number 1275131054
LBN Legal business name Clontz, Ethan Brody
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 13th, 2020
Last updated May 24th, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275131054 NPPES
South Carolina MEDICAID 4496PA

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