Provider Demographics
NPI:1750389292
Name:TASE, DOUGLAS S (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:S
Last Name:TASE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-3670
Mailing Address - Fax:856-968-8588
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 408
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-968-3670
Practice Address - Fax:856-968-8588
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027972E207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA09002900OtherSTATE LIC
PA135679D97Medicare ID - Type Unspecified
NJMA09002900OtherSTATE LIC