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Organization

JASON A TATE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DIANNE TATE (PRACTICE ADMINISTRATOR)
(410) 756-9110
Entity
Organization

Contact information

Practice address
76 FREDERICK ST, TANEYTOWN, MD 21787-2135
(410) 756-9110
Mailing address
PO BOX 973, WESTMINSTER, MD 21158-0973
(410) 848-5785
(410) 848-5629

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1906011
MD
Enumeration date
01/23/2018
Last updated
01/23/2018
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