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General NPI Number Information
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NPI Number | 1861805046
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Entity Type | Individual
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Provider Name | ELI CRAVEN TATE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2014
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 101 MANNING DR RM 1017
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City | CHAPEL HILL
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State | NC
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Zip | 27514-4220
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Country | US
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Telephone | 984-974-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MANNING DR RM 1017
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City | CHAPEL HILL
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State | NC
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Zip | 27514-4220
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Country | US
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Telephone | 984-974-1072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL36890
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 208443
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License Number State | NC
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