MEDICARE: MARK D NIEHAUS MD

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
1	208000000X	Pediatrics Physician	0101234414	VA
2	207R00000X	Internal Medicine Physician	0101234414	VA

General Provider Information

NPI Number	:	1972541548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D NIEHAUS MD

Provider Business Mailing Address
First Line	:	406 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7400
Country	:	US
Telephone Number	:	434-422-1919
Fax Number	:	434-202-4510

Provider Business Practice Location Address
First Line	:	416 ALBEMARLE SQ
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-7400
Country	:	US
Telephone Number	:	434-422-1919
Fax Number	:	434-402-4510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/07/2025

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