Provider Demographics
NPI:1588638274
Name:NIU, TINGTING (PA-C)
Entity Type:Individual
Prefix:
First Name:TINGTING
Middle Name:
Last Name:NIU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10724 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3249
Mailing Address - Country:US
Mailing Address - Phone:410-997-5944
Mailing Address - Fax:
Practice Address - Street 1:10724 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3106
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ54022Medicare UPIN
DC018170P50Medicare ID - Type Unspecified
MDKQ58M630Medicare ID - Type Unspecified