Healthcare Provider Details

I. General information

NPI: 1851979959
Provider Name (Legal Business Name): NICHOLAS MARTIN HEITKAMP MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX 800501
CHARLOTTESVILLE VA
22908-1971
US

IV. Provider business mailing address

5665 N COLLEGE AVE
INDIANAPOLIS IN
46220-3187
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: