ANDREW JACKSON ETHERIDGE IV CCA, CFO, CFM, CPED
Complete NPI Record 1487246369
Anaplastologist in Baltimore, MD
Active since February 11, 2021
Complete NPI Dataset
This page contains the complete raw NPPES record for Andrew Jackson Etheridge IV, CCA, CFO, CFM, CPED (NPI 1487246369), an individual anaplastologist provider in Baltimore, MD. All 35 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1487246369 Field 1/35
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/35
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: ETHERIDGE Field 3/35
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: ANDREW Field 4/35
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: JACKSON Field 5/35
- The middle name of the provider, if the provider is an individual.
- Provider Name Suffix Text: IV Field 6/35
- The name suffix of the provider if the provider is an individual. The name suffix is a "generation-related" suffix, such as Jr., Sr., II, III, IV, or V.
- Provider Credential Text: CCA, CFO, CFM, CPED Field 7/35
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider First Line Business Mailing Address: 6201 GREENLEIGH AVE Field 8/35
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: BALTIMORE Field 9/35
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: MD Field 10/35
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 212202004 Field 11/35
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 12/35
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider Business Mailing Address Telephone Number: 4109336423 Field 13/35
- The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
- Provider First Line Business Practice Location Address: 601 N CAROLINE ST FL 6 Field 14/35
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: BALTIMORE Field 15/35
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: MD Field 16/35
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 212870006 Field 17/35
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 18/35
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 4109558215 Field 19/35
- The telephone number associated with the location address of the provider being identified.
- Provider Business Practice Location Address Fax Number: 4109551085 Field 20/35
- The fax number associated with the location address of the provider being identified.
- Provider Gender Code: M Field 23/35
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 156FX1700X Field 24/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 25/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 224900000X Field 26/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 2: N Field 27/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 3: 224L00000X Field 28/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 3: N Field 29/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 4: 225000000X Field 30/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 4: N Field 31/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 5: 229N00000X Field 32/35
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 5: Y Field 33/35
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 34/35
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 1
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
2613 Carver St
Location 1/1Durham, NC 27705-2720 · Phone (919) 383-1205
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