Provider Demographics
NPI:1689210387
Name:TATE, TARREAH LOUISE
Entity Type:Individual
Prefix:
First Name:TARREAH
Middle Name:LOUISE
Last Name:TATE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 CHARRED OAK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1310
Mailing Address - Country:US
Mailing Address - Phone:301-257-1224
Mailing Address - Fax:
Practice Address - Street 1:20 CHESAPEAKE ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-2828
Practice Address - Country:US
Practice Address - Phone:202-731-5925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant