Provider Demographics
NPI:1336175173
Name:SHRATTER, LEE A (MD)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:A
Last Name:SHRATTER
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 1:15 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1604
Mailing Address - Country:US
Mailing Address - Phone:415-453-7967
Mailing Address - Fax:
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:925-296-7156
Practice Address - Fax:925-296-7174
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG540562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G540560Medicaid
CACH610ZMedicare PIN
CA00G540562Medicare PIN
CA00G540560Medicaid
CA00G540569Medicare PIN
CAF14490Medicare UPIN
CA00G540564Medicare PIN
CACH610VMedicare PIN
CACH610XMedicare PIN
CACH610YMedicare PIN
CA00G540568Medicare PIN
CA00G540567Medicare PIN
CA00G540563Medicare PIN