Provider Demographics
NPI:1790312536
Name:CANTY, ETHAN ABRAHAM (MD)
Entity type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:ABRAHAM
Last Name:CANTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3811 VALLEY CENTRE DR # S99
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3318
Mailing Address - Country:US
Mailing Address - Phone:858-554-3200
Mailing Address - Fax:
Practice Address - Street 1:9833 PACIFIC HEIGHTS BLVD STE J
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4707
Practice Address - Country:US
Practice Address - Phone:858-458-0940
Practice Address - Fax:858-458-3688
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA185856207K00000X
CA185856208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics