Individual
DR. ETHAN K MCGANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
620 JOHN PAUL JONES CIR DEPT OF, PORTSMOUTH, VA 23708-2111
(540) 532-9762
Mailing address
412 WARREN CRES APT 1, NORFOLK, VA 23507-2241
(757) 953-2339
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
0101276776
VA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/29/2021
Last updated
11/04/2022
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