Provider Demographics
NPI:1003167420
Name:SETOLA, TAMARA JEANNE (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:JEANNE
Last Name:SETOLA
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 JOHNNYCAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2419
Mailing Address - Country:US
Mailing Address - Phone:410-804-3919
Mailing Address - Fax:410-719-6338
Practice Address - Street 1:7001 JOHNNYCAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2419
Practice Address - Country:US
Practice Address - Phone:410-719-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114538363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1992794051OtherGROUP NPI NUMBER