MEDICARE: DR. CHARLES ERNEST RATHKE 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	0101019524	VA

General Provider Information

NPI Number	:	1851378491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ERNEST RATHKE MD

Provider Business Mailing Address
First Line	:	216 MILL STREAM WAY
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3187
Country	:	US
Telephone Number	:	757-229-9394
Fax Number	:	757-229-9394

Provider Business Practice Location Address
First Line	:	1550 TOMCAT BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23460-2218
Country	:	US
Telephone Number	:	757-314-7128
Fax Number	:	757-436-6843

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

Provider Enumeration Date	:	12/25/2005
Last Update Date	:	07/08/2007

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