Provider Demographics
NPI:1053356212
Name:CHIU, MARY ANNA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANNA
Last Name:CHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 N LIDGERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-1224
Mailing Address - Country:US
Mailing Address - Phone:509-482-2448
Mailing Address - Fax:
Practice Address - Street 1:5633 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1224
Practice Address - Country:US
Practice Address - Phone:509-482-2448
Practice Address - Fax:509-482-2452
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8472086Medicaid
MT1053356212Medicaid
WAG000362000OtherMEDICARE GROUP
WA1053356212Medicaid
WAG000362000OtherMEDICARE GROUP
MT1053356212Medicaid