Provider Demographics
NPI:1386902039
Name:RATTENBURY, HEATHER THU (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:THU
Last Name:RATTENBURY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-722-3417
Mailing Address - Fax:607-722-7610
Practice Address - Street 1:1290 UPPER FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-1046
Practice Address - Country:US
Practice Address - Phone:607-722-3417
Practice Address - Fax:607-722-7610
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY272759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program