Provider Demographics
NPI:1164456505
Name:RATINO, JEFFREY L (AA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:RATINO
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5880 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-0907
Mailing Address - Country:US
Mailing Address - Phone:440-221-8308
Mailing Address - Fax:440-579-0191
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-9604
Practice Address - Country:US
Practice Address - Phone:216-444-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67.000050367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH67000050OtherSTATE MEDICAL BOARD OF OH
OH2250746Medicaid
OH8225343Medicare ID - Type Unspecified
OH2250746Medicaid
OH8225344Medicare ID - Type Unspecified