Individual
DR. ETHAN ANDREW MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
3400 SPRUCE ST, PHILADELPHIA, PA 19104-4238
(215) 662-4829
Mailing address
3400 CIVIC CENTER BLVD FL 6, PHILADELPHIA, PA 19104-5162
(215) 662-3957
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
334916
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2020
Last updated
05/22/2025
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