Provider Demographics
NPI:1295712784
Name:RACHEDI, MARTHA P (MD)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:P
Last Name:RACHEDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4150
Practice Address - Street 1:835 SWEITZER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1007
Practice Address - Country:US
Practice Address - Phone:937-548-1141
Practice Address - Fax:937-619-4150
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064254207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0919199Medicaid
OHRA4126344Medicare ID - Type Unspecified
OH0919199Medicaid