Provider Demographics
NPI:1023346335
Name:RAFAL, HEATHER M (DPM)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:RAFAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 NICHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2589
Mailing Address - Country:US
Mailing Address - Phone:267-475-5174
Mailing Address - Fax:
Practice Address - Street 1:1601 MILLTOWN RD STE 24
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4084
Practice Address - Country:US
Practice Address - Phone:302-998-0178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005846213EP1101X, 213ES0103X
DEE10000197213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE10000197OtherLICENSE NUMBER