Provider Demographics
NPI:1821118662
Name:ANSELMI-MOULAYE, TINA MARIE (CNM)
Entity Type:Individual
Prefix:
First Name:TINA MARIE
Middle Name:
Last Name:ANSELMI-MOULAYE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 631568
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 WEST RD STE 300A
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2335
Practice Address - Country:US
Practice Address - Phone:410-321-6100
Practice Address - Fax:443-275-2465
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150036367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD176262701Medicaid