Individual ProviderTamara MedinaNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address201 S Cleveland Ave, Hagerstown, MD 21740-5745(301) 745-3777PECOS EnrollmentBased on the most recent information from CMS, provider Tamara Medina is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1295138071Provider TypeIndividualFull NameMedina, TamaraGenderFemaleSole ProprietorNoEnumeration Date10/7/2014Last Updated12/8/2020Contact InformationPractice LocationPractice Address201 S Cleveland Ave, Hagerstown, MD 21740-5745Phone(301) 745-3777FaxUnlisted FaxMailing LocationMailing Address7055 Samuel Morse Dr, Suite 200, Columbia, MD 21046-3439PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LP0808XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseR189621Maryland