Provider Demographics
NPI:1407681356
Name:TATE, WALTER MANLEY (PA-C)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:MANLEY
Last Name:TATE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5175 FEESER RD W
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2836
Mailing Address - Country:US
Mailing Address - Phone:443-974-0790
Mailing Address - Fax:
Practice Address - Street 1:5175 FEESER RD W
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2836
Practice Address - Country:US
Practice Address - Phone:443-974-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical