Provider Demographics
NPI:1972541548
Name:NIEHAUS, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:NIEHAUS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ALBEMARLE SQ
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-7400
Mailing Address - Country:US
Mailing Address - Phone:434-422-1919
Mailing Address - Fax:434-202-4510
Practice Address - Street 1:416 ALBEMARLE SQ
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-7400
Practice Address - Country:US
Practice Address - Phone:434-422-1919
Practice Address - Fax:434-402-4510
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234414208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4143502OtherUNITED HEALTHCARE/MAMSI
VA345677OtherANTHEM
VA345677OtherANTHEM
VAP00625092Medicare PIN
VA017703A36Medicare PIN