Mr Ethan Revels, is a
Student In An Organized Health Care Education/training Program based in Charleston, South Carolina. Mr Ethan Revels is licensed to practice in South Carolina (license number ) and his current practice location is
15102 Sweet Pl, Charleston, South Carolina. He can be reached at his office (for appointments etc.) via phone at
(704) 689-3747.
NPI number for Mr Ethan Revels is 1578486155 and his current mailing address is 15102 Sweet Pl, Charleston, South Carolina. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1578486155.
Provider's Profile
| Full Name | Mr Ethan Revels |
|---|
| Gender | Male |
|---|
| Speciality | Student In An Organized Health Care Education/training Program |
|---|
| Location | 15102 Sweet Pl, Charleston, South Carolina |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1578486155
- Provider Enumeration Date: 07/31/2026
- Last Update Date: 07/31/2026
Medical Identifiers
Medical identifiers for Mr Ethan Revels such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1578486155 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | (* (Not Available)) | Secondary |
| 390200000X | Student In An Organized Health Care Education/training Program | (South Carolina) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Ethan Revels is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Ethan Revels,
15102 Sweet Pl,
Charleston, SC 29492-2831
Ph: (704) 689-3747 | Mr Ethan Revels,
15102 Sweet Pl,
Charleston, SC 29492-2831
Ph: (704) 689-3747 |
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