Provider Demographics
NPI:1376529214
Name:RATCLIFF, LAWRENCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
Last Name:RATCLIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8996
Mailing Address - Fax:937-696-2198
Practice Address - Street 1:49 E CENTER ST
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:OH
Practice Address - Zip Code:45325-1110
Practice Address - Country:US
Practice Address - Phone:937-696-2858
Practice Address - Fax:937-696-2198
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039603207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0100608OtherUNITED EALTH CARE
OH35039603OtherMEDICAL LICENSE
OH080188500OtherRAILROAD MEDICARE
OH0451149Medicaid
OH421534506027OtherCARESOURCE
OH000000227890OtherANTHEM
OH635616OtherAETNA
OH000000227890OtherUNICARE
OH19813OtherNATIONWIDE
OHD3960307OtherHUMANA/CHOICECARE
OHD3960307OtherHUMANA/CHOICECARE
OHRA0437319Medicare PIN