STEPHEN N. ETHEREDGE MD – NPI #1770694101
Surgery

A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

STEPHEN ETHEREDGE is a surgeon located in OAKLAND, CA. NPPES has assigned the NPI number 1770694101 to STEPHEN ETHEREDGE on August 31, 2006. It is a Type-1 NPI, indicating this NPI number is associated with an individual. The primary taxonomy selected by this provider is 2086S0129X from the Health Care Provider Taxonomy code set, which is classified as Surgery, specializing in Vascular Surgery

The NPI profile was previously updated about 18 years ago on May 21, 2008. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for STEPHEN ETHEREDGE below.

NPI Profile for
STEPHEN N. ETHEREDGE

NPI Number
1770694101
Enumeration Date

(about 20 years ago)
Entity Type
Type-1  Individual (Male)
Legal Name
STEPHEN N. ETHEREDGE
Credentials
MD
Primary location
365 HAWTHORNE AVE
STE 103
OAKLAND, CA 94609-3107
Phone: (510) 832-6131 Fax:
Mailing address
Same as primary location
Sole Proprietor
No
Updated
Identifiers

Identifiers for STEPHEN ETHEREDGE

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDCA00C386470
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2086S0129X
- Surgery / Vascular Surgery (Primary)
CA C38647

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.