Provider Demographics
NPI:1780637561
Name:RATCLIFF, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:RATCLIFF
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 1:22762 OSPREY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5050
Mailing Address - Country:US
Mailing Address - Phone:276-466-4931
Mailing Address - Fax:
Practice Address - Street 1:565 RADIO HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-6587
Practice Address - Country:US
Practice Address - Phone:276-782-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237075207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
0907130010OtherCIGNA GOVERNMENT CVFP
VA1780637561Medicaid
308553OtherANTHEM CVFP
015064C58OtherMEDICARE INDIVIDUAL PTAN CVFP
2172994OtherUNITED HEALTHCARE GROUP CVFP
WV5630350000Medicaid
5934513OtherAETNA CVFP
C03658OtherMEDICARE GROUP PTAN CVFP
5934513OtherAETNA CVFP
C03658OtherMEDICARE GROUP PTAN CVFP
0907130010OtherCIGNA GOVERNMENT CVFP