1043483712 NPI number — FREDERICKA C TATE MD

Table of content: FREDERICKA C TATE MD (NPI 1043483712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043483712 NPI number — FREDERICKA C TATE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TATE
Provider First Name:
FREDERICKA
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1043483712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6113 WEST MILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOURTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-643-9151
Provider Business Mailing Address Fax Number:
215-836-1087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 NORTH BETHLEHEM PIKE SUITE 200B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGHOUSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19477
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-643-9151
Provider Business Practice Location Address Fax Number:
215-836-1087
Provider Enumeration Date:
04/02/2008

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: 2084P0800X , with the licence number:  MD011929E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B004643700 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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