Healthcare Provider Details

I. General information

NPI: 1740270214
Provider Name (Legal Business Name): MICHAEL ALLEN RATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 BRISTOL DR STE 101
SOUTH EASTON MA
02375-1916
US

IV. Provider business mailing address

45 BRISTOL DR STE 101
SOUTH EASTON MA
02375-1916
US

V. Phone/Fax

Practice location:
  • Phone: 781-530-8503
  • Fax:
Mailing address:
  • Phone: 781-530-8503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number81171
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number81171
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number81171
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: