Provider Demographics
NPI:1942394952
Name:ESKRIDGE, ETTA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ETTA
Middle Name:MARY
Last Name:ESKRIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-0553
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-5067
Practice Address - Fax:585-922-2908
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209932207R00000X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6960608-012OtherCIGNA
NY00001938416 03OtherUNITED HEALTHCARE
NY6018946OtherMVP
NY6C6477OtherHEALTHNET
NY766AV2OtherBLUE CROSS/BLUE SHIELD
NY5060783OtherAETNA/US HEALTHCARE
NY01867761Medicaid
NYP2203255OtherOXFORD
NY76AV1OtherBLUE CROSS/BLUE SHIELD
NY40C441Medicare PIN
NY766AV2OtherBLUE CROSS/BLUE SHIELD
NY5060783OtherAETNA/US HEALTHCARE
NY00001938416 03OtherUNITED HEALTHCARE