Glen Edward Tate, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0101034417 Issued in VA

Practice address

14558 Danville Pike
Laurel Fork, VA 24352-3982

Phone

(276) 398-2292

Fax

(276) 398-3331

NPI assigned

Jun 9, 2005

Last updated

Mar 5, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614902400000",
    "number": "1720082555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "LAUREL FORK",
            "state": "VA",
            "postal_code": "243520009",
            "telephone_number": "276-398-2292",
            "fax_number": "276-398-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14558 DANVILLE PIKE",
            "city": "LAUREL FORK",
            "state": "VA",
            "postal_code": "243523982",
            "telephone_number": "276-398-2292",
            "fax_number": "276-398-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "GLEN",
        "middle_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-09",
        "last_updated": "2021-03-05",
        "certification_date": "2021-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101034417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007608942",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "wedonotusethis",
            "affiliation": "N",
            "address_1": "14558 Danville Pike",
            "city": "Laurel Fork",
            "state": "VA",
            "country_code": "US",
            "postal_code": "243523982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bill McFeature, LPC
• Brian Douglas Miller, PHARMD
• Jeffrey Stewart Peele, MD
• Dinah P Perdue, FNP
• Robert George Schuster, D.D.S.
• Tri Area Community Health (Tri Area Community Health National Diabetes Prevention Program)
• Tri Area Community Health (Tri Area Community Health at Laurel Fork)
• Tri Area Community Health (Tri Area Pharmacy)
• Tri Area Community Health (Tri-Area Community Pharmacy at Laurel Fork)
• Jacqueline L Webb, PNP

• Family Medicine Physician in Laurel Fork, VA
• Providers in Laurel Fork, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.