MEDICARE: WIJAYAN RATNATHICAM MD

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	208600000X	Surgery Physician	130531	NY

General Provider Information

NPI Number	:	1336145358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WIJAYAN RATNATHICAM MD

Provider Business Mailing Address
First Line	:	1985 CROMPOND RD
Second Line	:	BLDG A
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-4146
Country	:	US
Telephone Number	:	914-736-0050
Fax Number	:	914-736-2635

Provider Business Practice Location Address
First Line	:	1985 CROMPOND RD
Second Line	:	BLDG A
City	:	CORTLANDT MANOR
State	:	NY
Zip	:	10567-4146
Country	:	US
Telephone Number	:	914-736-0050
Fax Number	:	914-736-2635

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	09/08/2010

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