Individual provider · Type 1 NPI

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

Anaplastologist · Baltimore, MD

NPI number 1487246369 Active

Practice location

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

Call (410) 955-8215 Map

Fax (410) 955-1085

Mailing address

6201 Greenleigh Ave
Baltimore, MD 21220-2004

Other practice locations

  • 2613 Carver St, Durham, NC 27705-2720 · (919) 383-1205

Specialties and licenses

TaxonomyCodeLicense
Ocularist 156FX1700XNone listed
Mastectomy Fitter 224900000XNone listed
Pedorthist 224L00000XNone listed
Orthotic Fitter 225000000XNone listed
Anaplastologist Primary 229N00000XNone listed

Anaplastologist: 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…

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About NPI 1487246369

Andrew Jackson Etheridge Iv, CCA, CFO, CFM, CPED's National Provider Identifier is 1487246369, issued on Feb 11, 2021. The primary taxonomy on file is Anaplastologist (229N00000X), and the practice location is in Baltimore, MD. The record was last updated on Aug 30, 2022.