Provider Demographics
NPI:1346878337
Name:TATE, SAMUEL ERIC (DO)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ERIC
Last Name:TATE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WATER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3036
Mailing Address - Country:US
Mailing Address - Phone:508-902-9705
Mailing Address - Fax:
Practice Address - Street 1:117 WATER ST STE 205
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3036
Practice Address - Country:US
Practice Address - Phone:508-902-9705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1019880207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program