1285660183 NPI number — HEATHER M VAN RAALTE M.D.

Table of content: HEATHER M VAN RAALTE M.D. (NPI 1285660183)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285660183 NPI number — HEATHER M VAN RAALTE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAN RAALTE
Provider First Name:
HEATHER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGEHEAN
Provider Other First Name:
HEATHER
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285660183
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 FORRESTAL RD S
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08540-6666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-924-2230
Provider Business Mailing Address Fax Number:
609-924-5006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 FORRESTAL RD S
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08540-6666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-924-2230
Provider Business Practice Location Address Fax Number:
609-924-5006
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD426505 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 25MA08415500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1360068 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2052999000 . This is a "INDEPENDENCE BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 03233300 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1084443 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00372672 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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