Basil E Fomanka

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

R198010 Issued in MD

Practice address

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

Phone

(443) 520-8138

NPI assigned

Jan 13, 2023

Last updated

Sep 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Gebaj Mental Health and Core Services Clinic, Inc

  • Psychiatric/Mental Health Registered Nurse
  • Riverdale, MD
  • NPI 1922866011

  DC

  Medicare reassignment NPD Authorized official
• Ace Behavioral Health Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Houston, TX
  • NPI 1447884333
  Medicare reassignment NPD
• Abundant Life Nursing Services Inc.

  • Home Health Agency
  • Randallstown, MD
  • NPI 1346589470
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1013621010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6200 BALTIMORE AVE STE 300-R9",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371054",
            "telephone_number": "443-520-8138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6200 BALTIMORE AVE",
            "address_2": "300-R9",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207371054",
            "telephone_number": "443-520-8138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOMANKA",
        "first_name": "BASIL",
        "middle_name": "E",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-01-13",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MD",
            "license": "R198010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harry Fleurant, DC
• Eduardo B Flores, MD
• Zainab Fofanah
• Derick Folefac
• William T Folefac
• Levis Forbang
• Nancy Fornah
• George Glenn France Jr., PTA
• Fredisia Clavenda Francis-Attipoe, M.D.
• Kathleen T Frankle, DDS

• Psychiatric/Mental Health Nurse Practitioner in Riverdale, MD
• Providers in Riverdale, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.