Healthcare Provider Details

I. General information

NPI: 1346878337
Provider Name (Legal Business Name): SAMUEL ERIC TATE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 06/21/2024
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 WATER ST STE 205
MILFORD MA
01757-3036
US

IV. Provider business mailing address

117 WATER ST STE 205
MILFORD MA
01757-3036
US

V. Phone/Fax

Practice location:
  • Phone: 508-902-9705
  • Fax:
Mailing address:
  • Phone: 508-902-9705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1019880
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: