Individual
ETHAN FADALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1809 W OREGON AVE STE 100, PHILADELPHIA, PA 19145-3700
(215) 389-3890
(215) 551-0368
Mailing address
2225 N COLLEGE AVE, PHILADELPHIA, PA 19121-4808
(570) 898-9884
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061845
PA
Other
Enumeration date
12/17/2020
Last updated
07/30/2025
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