Provider Demographics
NPI:1285660183
Name:VAN RAALTE, HEATHER M (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:VAN RAALTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:MCGEHEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 FORRESTAL RD S
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6666
Mailing Address - Country:US
Mailing Address - Phone:609-924-2230
Mailing Address - Fax:609-924-5006
Practice Address - Street 1:10 FORRESTAL RD S
Practice Address - Street 2:SUITE 205
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6666
Practice Address - Country:US
Practice Address - Phone:609-924-2230
Practice Address - Fax:609-924-5006
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD426505207V00000X
NJ25MA08415500207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1360068OtherHIGHMARK BLUE SHIELD
PA2052999000OtherINDEPENDENCE BLUE CROSS
PA03233300OtherCAPITAL BLUE CROSS
PA1084443OtherAETNA
P00372672OtherRAILROAD MEDICARE
PA2052999000OtherINDEPENDENCE BLUE CROSS
NJ143477ZCK0Medicare PIN