1346903051 NPI number — MRS. MARIE S TATE PMHNP

Table of content: MRS. MARIE S TATE PMHNP (NPI 1346903051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346903051 NPI number — MRS. MARIE S TATE PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
MARIE
Provider Middle Name:
S
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346903051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 E PATRICK ST UNIT 241
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21705-7511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-319-9404
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11670 OLD NATIONAL PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW MARKET
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21774-3161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-058-0842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  R179162 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)