Provider Demographics
NPI:1073609038
Name:SIU, BETTY (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:SIU
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 1:3510 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3233
Mailing Address - Country:US
Mailing Address - Phone:301-609-5200
Mailing Address - Fax:301-609-5220
Practice Address - Street 1:3510 OLD WASHINGTON RD
Practice Address - Street 2:SUITE #100
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3233
Practice Address - Country:US
Practice Address - Phone:301-609-5200
Practice Address - Fax:301-609-5220
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0062287OtherLICENSE
MDD0062287OtherLICENSE