Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | R193426 | MD |
NPI | 1194081588 |
---|---|
Provider Name | Mr. Timothy Henrique Anthony Madeira |
First Address | Baltimore, MD 21287-0010 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 14/10/2020 |