Healthcare Provider Details

I. General information

NPI: 1295720712
Provider Name (Legal Business Name): TIMOTHY J NITZSCHE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 MEDICAL CENTER DR ANESTHESIA DEPT
FISHERSVILLE VA
22939-2332
US

IV. Provider business mailing address

PO BOX 890580
CHARLOTTE NC
28289-0580
US

V. Phone/Fax

Practice location:
  • Phone: 540-427-4406
  • Fax: 540-427-4915
Mailing address:
  • Phone: 540-427-4406
  • Fax: 540-427-4915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101241108
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: