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NPI Code Detail

MEDICARE: MARY CLAIRE HEITHAUS PA-C

MEDICARE: MARY CLAIRE HEITHAUS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0010-16009NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548984537
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CLAIRE HEITHAUS PA-C
Provider Business Mailing Address
First Line : 1350 S KINGS DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28207-2134
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1350 S KINGS DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28207-2134
Country : US
Telephone Number : 980-442-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2022
Last Update Date : 02/07/2026

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Directions to “ MARY CLAIRE HEITHAUS PA-C” Practice Location

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