Provider Demographics
NPI:1689808677
Name:NATICK GENERAL PRACTICE P C
Entity Type:Organization
Organization Name:NATICK GENERAL PRACTICE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENTATA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RATUSZNIK-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-650-7615
Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:508-650-7616
Mailing Address - Fax:508-650-7814
Practice Address - Street 1:67 UNION ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-7700
Practice Address - Country:US
Practice Address - Phone:508-650-7616
Practice Address - Fax:508-650-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0010881Medicare PIN
MAG53610Medicare UPIN