Provider Demographics
NPI:1336156108
Name:CHARDON-BORRERO, MADAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MADAI
Middle Name:
Last Name:CHARDON-BORRERO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MADAI
Other - Middle Name:
Other - Last Name:CHARDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2305 WINDSWEPT CT
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1327
Mailing Address - Country:US
Mailing Address - Phone:410-941-5394
Mailing Address - Fax:877-240-2092
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:DEARTMENT OF MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7155
Practice Address - Fax:877-240-2092
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD788003100Medicaid
MDH36432Medicare UPIN
MDS69RMedicare ID - Type Unspecified