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General NPI Number Information
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NPI Number | 1972541548
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Entity Type | Individual
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Provider Name | MARK D NIEHAUS MD
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Gender | Male
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 416 ALBEMARLE SQ
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-7400
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Country | US
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Telephone | 434-422-1919
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Fax | 434-402-4510
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Provider Business Mailing Address
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Address Line | 406 ALBEMARLE SQ
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22901-7400
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Country | US
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Telephone | 434-422-1919
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Fax | 434-202-4510
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0101234414
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101234414
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License Number State | VA
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