Provider Demographics
NPI:1053427070
Name:RATERINK, MARK HENRY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:HENRY
Last Name:RATERINK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6100 UPTOWN BLVD NE STE 650
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4186
Mailing Address - Country:US
Mailing Address - Phone:505-340-0700
Mailing Address - Fax:505-340-0701
Practice Address - Street 1:6100 UPTOWN BLVD NE STE 650
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4186
Practice Address - Country:US
Practice Address - Phone:505-340-0700
Practice Address - Fax:505-340-0701
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020271208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72579081Medicaid
NM72579081Medicaid
NM332417400Medicare ID - Type Unspecified