Healthcare Provider Details

I. General information

NPI: 1497596274
Provider Name (Legal Business Name): ETHAN CHANAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2024
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 PENNSYLVANIA AVE SE STE 205
WASHINGTON DC
20020-3731
US

IV. Provider business mailing address

3230 PENNSYLVANIA AVE SE STE 205
WASHINGTON DC
20020-3731
US

V. Phone/Fax

Practice location:
  • Phone: 202-796-9775
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500125704
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: