Provider Demographics
NPI:1336150291
Name:TATE, JASON ATWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:ATWOOD
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2135
Mailing Address - Country:US
Mailing Address - Phone:410-756-9110
Mailing Address - Fax:410-756-2260
Practice Address - Street 1:76 FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2135
Practice Address - Country:US
Practice Address - Phone:410-756-9110
Practice Address - Fax:410-756-2260
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF42861Medicare UPIN