Provider Demographics
NPI:1992955058
Name:KO, ETHAN S (DO)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:S
Last Name:KO
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Gender:M
Credentials:DO
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Mailing Address - Street 1:609 JEFFERSON DAVIS HWY
Mailing Address - Street 2:201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-4436
Mailing Address - Country:US
Mailing Address - Phone:540-899-3107
Mailing Address - Fax:540-899-3183
Practice Address - Street 1:609 JEFFERSON DAVIS HWY
Practice Address - Street 2:201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4436
Practice Address - Country:US
Practice Address - Phone:540-899-3107
Practice Address - Fax:540-899-3183
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2018-09-13
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Provider Licenses
StateLicense IDTaxonomies
MN54475207R00000X
VA010220875207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine