Provider Demographics
NPI:1336185537
Name:RATLIFF, HENRY WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WESLEY
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 1:101 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2903
Mailing Address - Country:US
Mailing Address - Phone:609-924-6072
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE A-8
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-921-2689
Practice Address - Fax:609-279-1745
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA037477002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3839303Medicaid
NJD96408Medicare UPIN
NJRA38725Medicare ID - Type Unspecified