Healthcare Provider Details

I. General information

NPI: 1700140639
Provider Name (Legal Business Name): MARIAH BARKER PATE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

IV. Provider business mailing address

1330 S FORT HARRISON AVE
CLEARWATER FL
33756-3313
US

V. Phone/Fax

Practice location:
  • Phone: 727-441-3588
  • Fax: 727-461-1038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME132273
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: