Provider Demographics
NPI:1215030135
Name:RATNAKAR, MICHELLE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:RATNAKAR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2831
Mailing Address - Street 2:WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2831
Mailing Address - Country:US
Mailing Address - Phone:304-637-2360
Mailing Address - Fax:304-637-2362
Practice Address - Street 1:55 CHENOWETH CREEK RD
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-9237
Practice Address - Country:US
Practice Address - Phone:304-637-2360
Practice Address - Fax:304-637-2362
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00633363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001763928OtherMOUNTAIN STATE BCBS
WVWV633OtherHEALTH PLAN
WVPUPA25321Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NBR
WVWV633OtherHEALTH PLAN
WVPUPA25322Medicare PIN
WVQ49047Medicare UPIN