Provider Demographics
NPI:1790281780
Name:RATNER, DMITRY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DMITRY
Middle Name:
Last Name:RATNER
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 LEXINGTON ST
Mailing Address - Street 2:BLDG 8 APT 11
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452
Mailing Address - Country:US
Mailing Address - Phone:339-545-1650
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5400
Practice Address - Country:US
Practice Address - Phone:617-667-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA286314207ZM0300X, 207ZP0105X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program