Provider Demographics
NPI:1518981661
Name:GORSUCH-RAFFERTY, HEIDI D (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:D
Last Name:GORSUCH-RAFFERTY
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:540-564-7086
Mailing Address - Fax:540-564-6847
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 338
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6244
Practice Address - Country:US
Practice Address - Phone:571-261-3270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243118174400000X, 208600000X
IL036155910208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518981661Medicaid
VA018150R54Medicare PIN
VA1518981661OtherSOUTHERN HEALTH
WV3810011692Medicaid
VA354887OtherBCBS