Provider Demographics
NPI:1598745432
Name:TATE, MICHAEL JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TATE
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:17816 TIMBERLANE
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7040
Mailing Address - Country:US
Mailing Address - Phone:301-739-8633
Mailing Address - Fax:
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25405-9990
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:304-267-3899
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-16
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical