Provider Demographics
NPI:1003867276
Name:RATTNER, ZACHARY G (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:G
Last Name:RATTNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VALLEY STREAM PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1407
Mailing Address - Country:US
Mailing Address - Phone:610-644-8900
Mailing Address - Fax:484-924-0053
Practice Address - Street 1:995 GATEWAY CENTER WAY
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92102-4500
Practice Address - Country:US
Practice Address - Phone:619-263-9729
Practice Address - Fax:619-263-9730
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG868432085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00045312OtherRAILROAD MEDICARE PIN
CA00G868430OtherBLUE SHIELD PIN
CA00G868430Medicaid
CAWG86843EMedicare PIN
CA00G868430Medicaid
CAWG86843CMedicare PIN
BS023ZMedicare PIN
CAWG86843BMedicare PIN
CAG13908Medicare UPIN