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ANDREW JACKSON ETHERIDGE CCA CFO CFM CPED NPI 1487246369


NPI Information

NPI: 1487246369
Provider Name: ANDREW JACKSON ETHERIDGE, CCA, CFO, CFM, CPED
Classification: Anaplastologist - 229N00000X
Entity Type: Individual
Address:
601 N CAROLINE ST FL 6
BALTIMORE, MD
ZIP 21287
Phone: (410) 955-8215
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Andrew Jackson Etheridge, CCA, CFO, CFM, CPED is an anaplastologist in Baltimore, MD. The provider is an anaplastologist is a professional who creates prostheses for the face and body. Patients treated include those missing anatomy due to cancer, traumatic injury, or birth differences. Generally, there are no state licensing requirements for anaplastologists. Certification specific to anaplastology is provided through the Board for Certified Clinical Anaplastology (BCCA) with a credential title of Certified Clinical Anaplastologist (CCA). Andrew Jackson Etheridge, CCA, CFO, CFM, CPED NPI is 1487246369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

601 N CAROLINE ST FL 6
BALTIMORE, MD
ZIP 21287-006
Phone: (410) 955-8215
Fax: (410) 955-1085

The enumeration date for this NPI number is 2/11/2021 and was last updated on 8/30/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1156FX1700XTechnician/TechnologistOcularistNo
2224900000XMastectomy FitterNo
3224L00000XPedorthistNo
4225000000XOrthotic FitterNo
5229N00000XAnaplastologistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.