Healthcare Provider Details

I. General information

NPI: 1821027459
Provider Name (Legal Business Name): JON S RATTA P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE EMERGENCY DEPARTMENT
DOVER NH
03820-2526
US

IV. Provider business mailing address

PO BOX 845398
BOSTON MA
02284-5398
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-2163
  • Fax: 405-341-9217
Mailing address:
  • Phone: 800-684-1577
  • Fax: 405-844-1794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number785
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: