Provider Demographics
NPI:1821027459
Name:RATTA, JON S (PA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:S
Last Name:RATTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 845398
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-5398
Mailing Address - Country:US
Mailing Address - Phone:800-684-1577
Mailing Address - Fax:405-844-1794
Practice Address - Street 1:789 CENTRAL AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2526
Practice Address - Country:US
Practice Address - Phone:603-740-2163
Practice Address - Fax:405-341-9217
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00234856OtherRAILROAD MEDICARE
NH30011406Medicaid
NHAP0816Medicare PIN
NHAP081602Medicare PIN
NH30011406Medicaid