Provider Demographics
NPI:1619295805
Name:RATNAM, REBECCA SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:RATNAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3843 INGRAHAM ST APT F209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-6462
Mailing Address - Country:US
Mailing Address - Phone:305-781-5021
Mailing Address - Fax:
Practice Address - Street 1:1835 N FRANKLIN ST
Practice Address - Street 2:5 SOUTH TOWER #530
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1126
Practice Address - Country:US
Practice Address - Phone:303-866-8444
Practice Address - Fax:303-866-8446
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48848208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA100734Medicare PIN
COC805268Medicare Oscar/Certification