Provider Demographics
NPI:1447036371
Name:ELDRIDGE, MARIAH MARTIN
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:MARTIN
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:ALEXANDRIA
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE N APT 301
Mailing Address - Street 2:
Mailing Address - City:WAHPETON
Mailing Address - State:ND
Mailing Address - Zip Code:58075-4141
Mailing Address - Country:US
Mailing Address - Phone:704-978-9831
Mailing Address - Fax:
Practice Address - Street 1:800 6TH ST N
Practice Address - Street 2:
Practice Address - City:WAHPETON
Practice Address - State:ND
Practice Address - Zip Code:58076-0001
Practice Address - Country:US
Practice Address - Phone:701-630-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator