Healthcare Provider Details

I. General information

NPI: 1194081588
Provider Name (Legal Business Name): TIMOTHY HENRIQUE ANTHONY MADEIRA CRNP, APRN-CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

1800 ORLEANS ST STE 7107
BALTIMORE MD
21287-0010
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5080
  • Fax:
Mailing address:
  • Phone: 410-955-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberR193426
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License NumberCS00100
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: