Individual
SEAN MICHAEL ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
92 CAMPUS DR STE C, SCARBOROUGH, ME 04074-7229
(207) 797-5753
Mailing address
38 ACADEMY CIR, OAKLAND, NJ 07436-2625
(201) 783-5471
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2612
ME
Other
Enumeration date
08/09/2020
Last updated
07/09/2024
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