MEDICARE: MICHELLE LYNN RATNAKAR PA-C

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	363A00000X	Physician Assistant	00633	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001763928	OTHER	WV	MOUNTAIN STATE BCBS
2	WV633	OTHER	WV	HEALTH PLAN

General Provider Information

NPI Number	:	1215030135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN RATNAKAR PA-C

Provider Business Mailing Address
First Line	:	PO BOX 2831
Second Line	:	WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
City	:	ELKINS
State	:	WV
Zip	:	26241-2831
Country	:	US
Telephone Number	:	304-637-2360
Fax Number	:	304-637-2362

Provider Business Practice Location Address
First Line	:	55 CHENOWETH CREEK RD
Second Line	:
City	:	ELKINS
State	:	WV
Zip	:	26241-9237
Country	:	US
Telephone Number	:	304-637-2360
Fax Number	:	304-637-2362

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	04/26/2018

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