Individual provider · Type 1 NPI

Basil E. Fomanka

Psychiatric/Mental Health Nurse Practitioner · Riverdale, MD

NPI number 1013621010 Active

Practice location

6200 Baltimore Ave, 300-R9
Riverdale, MD 20737-1054

Mailing address

6200 Baltimore Ave Ste 300-R9
Riverdale, MD 20737-1054

Specialties and licenses

TaxonomyCodeLicense
Psychiatric/Mental Health Nurse Practitioner Primary 363LP0808XR198010 (MD)

Psychiatric/Mental Health Nurse Practitioner: Definition to come...

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About NPI 1013621010

Basil E. Fomanka's National Provider Identifier is 1013621010, issued on Jan 13, 2023. The primary taxonomy on file is Psychiatric/Mental Health Nurse Practitioner (363LP0808X), and the practice location is in Riverdale, MD. The record was last updated on Sep 18, 2025.