Provider Demographics
NPI:1750631768
Name:GANABATHI, RATNA (DO)
Entity Type:Individual
Prefix:DR
First Name:RATNA
Middle Name:
Last Name:GANABATHI
Suffix:
Gender:F
Credentials:DO
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1648 HUNTINGDON PIKE
Mailing Address - Street 2:MEDICAL STAFF OFFICE FIRST FLOOR
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8001
Mailing Address - Country:US
Mailing Address - Phone:215-938-3450
Mailing Address - Fax:215-938-3829
Practice Address - Street 1:1648 HUNTINGDON PIKE
Practice Address - Street 2:MEDICAL STAFF OFFICE FIRST FLOOR
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8001
Practice Address - Country:US
Practice Address - Phone:215-938-3450
Practice Address - Fax:215-938-3829
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS020113207R00000X
NJCURRENTLY APPLYING207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty