Individual
ETHAN M DYMOND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1215 LEE ST, CHARLOTTESVILLE, VA 22908-4319
(434) 924-5428
(434) 243-0649
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
(434) 295-1000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008580
VA
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
05/18/2022
Last updated
11/06/2023
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