ANDREW JACKSON ETHERIDGE IV CCA, CFO, CFM, CPED
NPI 1487246369
Anaplastologist in Baltimore, MD

Q: What is Andrew Etheridge's NPI number?

The NPI number for Andrew Etheridge is 1487246369. It was assigned to this individual provider in the NPPES registry on February 11, 2021.

Q: What is Andrew Etheridge's specialty?

The primary specialty registered for this NPI is Anaplastologist with taxonomy code 229N00000X.

Q: When was this NPI record last updated?

The NPPES record for Andrew Etheridge was last updated on August 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since February 11, 2021

601 N CAROLINE ST FL 6, BALTIMORE, MD 21287(410) 955-8215(410) 955-1085 Get Directions Write a Review

NPPES record last updated: August 30, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 30, 2022, Feb 11, 2021 (2 updates tracked since 2021).

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About Andrew Jackson Etheridge Iv Cca, Cfo, Cfm, Cped NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ANDREW JACKSON ETHERIDGE IV CCA, CFO, CFM, CPED (NPI 1487246369) is an individual anaplastologist provider in Baltimore, Maryland and active in the NPI registry since February 2021. He maintains a secondary practice location in Durham.

NPPES Registry Identity

NPI1487246369

Entity TypeIndividualMale

Primary Taxonomy229N00000X

Provider Legal NameANDREW JACKSON ETHERIDGE IVCredential: CCA, CFO, CFM, CPED

Location Address601 N CAROLINE ST FL 6Baltimore, MD 21287-0006

Mailing Address6201 Greenleigh AveBaltimore, MD 21220-2004 · (410) 933-6423

Phone(410) 955-8215

Fax(410) 955-1085

Sole ProprietorNo

Enumeration DateFebruary 11, 2021

Last NPPES UpdateAugust 30, 20222 updates tracked since enumeration

NPPES CertifiedAugust 30, 2022

✔ NPI 1487246369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 5

★ Primary SpecialtyAnaplastologistRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code229N00000X

Definition

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).

Also ListedTechnician/Technologist · OcularistTaxonomy 156FX1700X

Also ListedMastectomy FitterTaxonomy 224900000X

Also ListedPedorthistTaxonomy 224L00000X

Also ListedOrthotic FitterTaxonomy 225000000X

601 N CAROLINE ST FL 6, Baltimore, MD 21287

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Secondary Practice Location 1

Location 12613 Carver StDurham, NC 27705-2720 · Phone (919) 383-1205

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JUAN R GARCIA JR. CCA

Anaplastologist