Provider Demographics
NPI:1306980073
Name:VICINO, TANZANIA (CNM)
Entity type:Individual
Prefix:
First Name:TANZANIA
Middle Name:
Last Name:VICINO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:TANZANIA
Other - Middle Name:
Other - Last Name:TOMPKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3319 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5103
Mailing Address - Country:US
Mailing Address - Phone:410-542-7800
Mailing Address - Fax:443-836-0405
Practice Address - Street 1:3319 W BELVEDERE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5103
Practice Address - Country:US
Practice Address - Phone:410-542-7800
Practice Address - Fax:443-836-0405
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000422207V00000X
MDR190581367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDAC000422OtherRN LICENSE