MEDICARE: TANIA GERTRUDE NIAMKEY CRNP-PMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R210475	MD
2	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician	R210475	MD

General Provider Information

NPI Number	:	1134914567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA GERTRUDE NIAMKEY CRNP-PMH

Provider Business Mailing Address
First Line	:	2641 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4518
Country	:	US
Telephone Number	:	240-355-1475
Fax Number	:

Provider Business Practice Location Address
First Line	:	2641 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-4518
Country	:	US
Telephone Number	:	240-355-1475
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2025
Last Update Date	:	04/21/2026

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