Basic Information
| Provider Information | |||||||||
| NPI: | 1750373544 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATLIFF | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 582 BLUE RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245232604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404257910 | ||||||||
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| Practice Location | |||||||||
| Address1: | 582 BLUE RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404257910 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0101260514 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | SM597491 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0011973400004 | 05 | PA | MEDICAID | 01952201 | 01 | PA | CAIC | OTHER |