Provider Demographics
NPI:1972397073
Name:TIEMUNJI, MARIUS TIALEH
Entity type:Individual
Prefix:
First Name:MARIUS
Middle Name:TIALEH
Last Name:TIEMUNJI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 BLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4202
Mailing Address - Country:US
Mailing Address - Phone:443-744-0455
Mailing Address - Fax:
Practice Address - Street 1:1907 WINDER RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-1730
Practice Address - Country:US
Practice Address - Phone:443-985-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant