Provider Demographics
NPI:1740569805
Name:RATLIFF, DAVID FRED (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:FRED
Last Name:RATLIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HAMBURG TPKE STE C
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6250
Mailing Address - Country:US
Mailing Address - Phone:973-898-5999
Mailing Address - Fax:973-831-2025
Practice Address - Street 1:2025 HAMBURG TPKE STE C
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6250
Practice Address - Country:US
Practice Address - Phone:973-898-5999
Practice Address - Fax:973-831-2025
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262236207XS0106X
NJ25MA09643600207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA09643600OtherNJ MEDICAL LICENSE
NY262236OtherLICENSE