Provider Demographics
NPI:1912971284
Name:RATUSZNIK-MARTIN, RENATA (MD)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:
Last Name:RATUSZNIK-MARTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 UNION ST
Mailing Address - Street 2:# 303
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-7700
Mailing Address - Country:US
Mailing Address - Phone:617-414-4465
Mailing Address - Fax:617-414-3345
Practice Address - Street 1:850 HARRISON AVE
Practice Address - Street 2:YAWKEY 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-4072
Practice Address - Country:US
Practice Address - Phone:617-414-2080
Practice Address - Fax:617-414-2090
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2018-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA159545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3202895Medicaid
MA3202895Medicaid
MAG53610Medicare UPIN