Provider Demographics
NPI:1417061383
Name:SNEARLY, MARTHA DAMASKE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:DAMASKE
Last Name:SNEARLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:DAMASKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE AVE E
Mailing Address - Street 2:#1200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1158
Mailing Address - Country:US
Mailing Address - Phone:216-479-5541
Mailing Address - Fax:216-479-5554
Practice Address - Street 1:12301 SNOW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1002
Practice Address - Country:US
Practice Address - Phone:216-621-5600
Practice Address - Fax:216-362-2749
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-033832207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0299190Medicaid
OH0722331Medicare PIN
F36598Medicare UPIN
OH0299190Medicaid
DA0722331Medicare ID - Type Unspecified