=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760702096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID M. HEILBRONNER, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2010
-----------------------------------------------------
Last Update Date | 06/09/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 914 E JEFFERSON ST SUITE 102
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22902-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-296-8200
-----------------------------------------------------
Fax | 434-977-6613
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 914 E JEFFERSON ST SUITE 102
-----------------------------------------------------
City | CHARLOTTESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22902-4745
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-296-8200
-----------------------------------------------------
Fax | 434-977-6613
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SECRETARY/TREASURER
-----------------------------------------------------
Name | DR. DAVID MARK HEILBRONNER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 434-296-8200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101035825
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------