Provider Demographics
NPI:1740326123
Name:HURTADO, RAFAEL V (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:V
Last Name:HURTADO
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 1:178 EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4100
Mailing Address - Country:US
Mailing Address - Phone:434-792-3232
Mailing Address - Fax:434-792-3236
Practice Address - Street 1:178 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4100
Practice Address - Country:US
Practice Address - Phone:434-792-3232
Practice Address - Fax:434-792-3236
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012383332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10001325Medicaid
VA184948OtherANTHEM BLUE CROSS BLUE SH
NC5903333Medicaid
VA010207916Medicaid
325431OtherSOUTHERN HEALTH
VA184948OtherANTHEM BLUE CROSS BLUE SH
P00278011Medicare ID - Type UnspecifiedRAILROAD MEDICARE
VA010207916Medicaid