Provider Demographics
NPI:1083941355
Name:WEEMS, CHARDAE ANDREA
Entity Type:Individual
Prefix:
First Name:CHARDAE
Middle Name:ANDREA
Last Name:WEEMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 PENNSYLVANIA AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3111
Mailing Address - Country:US
Mailing Address - Phone:410-736-9683
Mailing Address - Fax:410-669-3829
Practice Address - Street 1:604 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-2828
Practice Address - Country:US
Practice Address - Phone:410-736-9683
Practice Address - Fax:410-669-3829
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00082196376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216364596AOtherMEDICARE