Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | MD08409 | RI |
NPI | 1013959808 |
---|---|
Provider Name | Charlene A Tate |
First Address | Providence, RI 02903-4141 |
Second Address | Providence, RI 02905-3236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7005405 | (05) | RI |
G26542 | (02) | RI |