Provider Demographics
NPI:1942959317
Name:MARTIN, CHARDAJHA M
Entity Type:Individual
Prefix:
First Name:CHARDAJHA
Middle Name:M
Last Name:MARTIN
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 1:443 RICHMOND PARK W APT D410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1830
Mailing Address - Country:US
Mailing Address - Phone:216-512-5242
Mailing Address - Fax:
Practice Address - Street 1:443 RICHMOND PARK W APT D410
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1830
Practice Address - Country:US
Practice Address - Phone:216-512-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide