MEDICARE: M QUINN TATE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	MD478700	PA
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	MD478700	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629426572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M QUINN TATE M.D.

Provider Business Mailing Address
First Line	:	1800 LOMBARD ST
Second Line	:	GROUND FLR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146
Country	:	US
Telephone Number	:	215-893-2600
Fax Number	:	215-893-2610

Provider Business Practice Location Address
First Line	:	1800 LOMBARD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1414
Country	:	US
Telephone Number	:	215-893-2600
Fax Number	:	215-893-2610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	03/12/2026

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