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NPI Code Detail

MEDICARE: DANITRA ETHERIDGE

MEDICARE: DANITRA ETHERIDGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLBA601MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1906931804OTHERMDUNITED HEALTH CARE

General Provider Information

NPI Number : 1336660224
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANITRA ETHERIDGE
Provider Business Mailing Address
First Line : 7120 SAMUEL MORSE DR STE 150
Second Line :
City : COLUMBIA
State : MD
Zip : 21046-3420
Country : US
Telephone Number : 888-344-5977
Fax Number :
Provider Business Practice Location Address
First Line : 4714 ARCADIA DR STE 100-125
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7662
Country : US
Telephone Number : 888-344-5977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2017
Last Update Date : 05/26/2025

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Directions to “ DANITRA ETHERIDGE ” Practice Location

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