Ethan Marshall Bulger

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

C0010237 Issued in MD

Practice address

17301 Valley Mall Rd Ste 125
Hagerstown, MD 21740-6966

Phone

(301) 790-9236

NPI assigned

Apr 24, 2024

Last updated

Mar 12, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Medical Practices of Antietam, LLCGroup PAC ID 2567353865, 229 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Medical Practices of Antietam LLC

  • Clinic/Center
  • Hagerstown, MD
  • NPI 1710854963
  Medicare reassignment Care Compare group NPD
• Medical Practices of Antietam, LLC

  • General Practice Physician
  • Hagerstown, MD
  • NPI 1558430843
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773273600000",
    "number": "1972359685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11116 MEDICAL CAMPUS RD",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217426710",
            "telephone_number": "301-824-3343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17301 VALLEY MALL RD STE 125",
            "city": "HAGERSTOWN",
            "state": "MD",
            "postal_code": "217406966",
            "telephone_number": "301-790-9236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 N Walnut St Fl 3",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217404738",
            "country_code": "US",
            "telephone_number": "240-527-2752",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "22911 Jefferson Blvd",
            "address_purpose": "LOCATION",
            "city": "Smithsburg",
            "state": "MD",
            "postal_code": "217831617",
            "country_code": "US",
            "telephone_number": "301-824-3343",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULGER",
        "first_name": "ETHAN",
        "middle_name": "MARSHALL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-04-24",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0010237",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janell K Budgett, LCSWC
• Atchuthanand Budi, MD
• Lakshmi Budi, MD
• Allyson Corine Buffington
• Lam Bui, DMD
• Wyatt Bunker, ATC, NREMT, PA-S1
• Carlina D Burcker
• Stacie Ann Burdge, LCPC
• Victoria Burgamy, LMSW
• Diane Burgan

• Physician Assistant in Hagerstown, MD
• Providers in Hagerstown, MD by specialty
• Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.