Healthcare Provider Details

I. General information

NPI: 1124118864
Provider Name (Legal Business Name): RATNA SRIDJAJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A.I. DUPONT HOSPITAL FOR CHILDREN 1600 ROCKLAND ROAD
WILMINGTON DE
19899
US

IV. Provider business mailing address

CORPORATE CREDENTIALING P.O. BOX 269
WILMINGTON DE
19899
US

V. Phone/Fax

Practice location:
  • Phone: 302-651-4000
  • Fax: 302-651-4945
Mailing address:
  • Phone: 302-651-5938
  • Fax: 302-651-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License NumberC1-0006937
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD067168L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: