MEDICARE: DR. SANDRA S RATLIFF 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	208000000X	Pediatrics Physician	0101260514	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SM597491	OTHER	PA	HIGHMARK BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	01952201	OTHER	PA	CAIC

General Provider Information

NPI Number	:	1750373544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA S RATLIFF MD

Provider Business Mailing Address
First Line	:	582 BLUE RIDGE AVE
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-2604
Country	:	US
Telephone Number	:	540-425-7910
Fax Number	:

Provider Business Practice Location Address
First Line	:	582 BLUE RIDGE AVE
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523
Country	:	US
Telephone Number	:	540-425-7910
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	03/10/2022

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