Provider Demographics
NPI:1043483712
Name:TATE, FREDERICKA C (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICKA
Middle Name:C
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 WEST MILL RD
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031
Mailing Address - Country:US
Mailing Address - Phone:215-643-9151
Mailing Address - Fax:215-836-1087
Practice Address - Street 1:1018 NORTH BETHLEHEM PIKE SUITE 200B
Practice Address - Street 2:
Practice Address - City:SPRINGHOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477
Practice Address - Country:US
Practice Address - Phone:215-643-9151
Practice Address - Fax:215-836-1087
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011929E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB004643700OtherBCBS
PAB004643700OtherBCBS