Provider Demographics
NPI:1467466961
Name:GORETSKY, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GORETSKY
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 1:601 CHILDRENS LN
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7703
Mailing Address - Fax:
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-025612086S0120X
VA01012257742086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA280541OtherMAMSI/OPTIMUM CHOICE
VA3116108340003EOtherCIGNA
VA311610834OtherNC HEALTH CHOICE
VA7712078OtherAETNA
VA006704441Medicaid
NC1467466961Medicaid
SCNC2352Medicaid
VA26053OtherOPTIMA/SENTARA HEATLH
VA280541OtherALLIANCE/MDIPA
VA89063ANOtherNORTH CAROLINA MEDICAID
NC89063ANMedicaid
VA216623OtherANTHEM BCBS
VAC06141Medicare PIN
SCNC2352Medicaid