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General NPI Number Information
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NPI Number | 1619866159
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Entity Type | Individual
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Provider Name | ETHAN DANIEL CAIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/30/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 505 N 4TH ST
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City | YOUNGWOOD
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State | PA
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Zip | 15697-1559
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Country | US
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Telephone | 724-925-1211
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Fax |
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Provider Business Mailing Address
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Address Line | 463 JEFFREYS DR
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City | ELIZABETH
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State | PA
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Zip | 15037-2833
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Country | US
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Telephone | 724-875-0056
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA066749
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License Number State | PA
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