Provider Demographics
NPI:1730346719
Name:TATE, STEPHEN M-L (HS3)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M-L
Last Name:TATE
Suffix:
Gender:M
Credentials:HS3
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 2ND ST SW SUIT
Mailing Address - Street 2:COMDT (CG-1122) US COAST GUARD
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 2ND ST SW SUIT
Practice Address - Street 2:COMDT (CG-1122) US COAST GUARD
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593
Practice Address - Country:US
Practice Address - Phone:313-231-7231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24720000X390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program