Andrew Jackson Etheridge IV, CCA, CFO, CFM, CPED

Primary specialty

AnaplastologistTaxonomy code 229N00000X

Practice address

601 N Caroline St FL 6
Baltimore, MD 21287-0006

Phone

(410) 955-8215

Fax

(410) 955-1085

NPI assigned

Feb 11, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• The Anaplastology Clinic, LLC

  • Anaplastologist
  • Durham, NC
  • NPI 1922244425
  NPD

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1487246369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-933-6423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 N CAROLINE ST FL 6",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212870006",
            "telephone_number": "410-955-8215",
            "fax_number": "410-955-1085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2613 Carver St",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277052720",
            "country_code": "US",
            "telephone_number": "919-383-1205",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "ANDREW",
        "middle_name": "JACKSON",
        "name_suffix": "IV",
        "credential": "CCA, CFO, CFM, CPED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-11",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1700X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Ocularist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225000000X",
            "taxonomy_group": "",
            "desc": "Orthotic Fitter",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "229N00000X",
            "taxonomy_group": "",
            "desc": "Anaplastologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hadassa Estrin
• Eta Medical Transport LLC
• Nicholas David Etchison
• Vahid Etezadi, MD
• Bridgett Etheridge-May
• Carrie H Etheridge, LCSW-C
• Nicholas A Etheridge, LCPC, NCC
• Ethical Care Group LLC
• Mary-Ann Adiaha-Obong Etiebet, MD
• Etienne T. Ngoumgna

• Anaplastologist in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Anaplastologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.