Individual
ETHAN LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1525 N CHURCH ST, HAZLE TOWNSHIP, PA 18202-9383
(570) 751-5900
(570) 751-5901
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6523
(570) 271-8056
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA066314
PA
Other
Enumeration date
02/06/2025
Last updated
03/31/2025
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