Healthcare Provider Details

I. General information

NPI: 1285660183
Provider Name (Legal Business Name): HEATHER M VAN RAALTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER M MCGEHEAN M.D.

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 FORRESTAL RD S SUITE 205
PRINCETON NJ
08540-6666
US

IV. Provider business mailing address

10 FORRESTAL RD S SUITE 205
PRINCETON NJ
08540-6666
US

V. Phone/Fax

Practice location:
  • Phone: 609-924-2230
  • Fax: 609-924-5006
Mailing address:
  • Phone: 609-924-2230
  • Fax: 609-924-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD426505
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA08415500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: