Provider Demographics
NPI:1710148994
Name:TIU, SUSAN ORDONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ORDONIO
Last Name:TIU
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5468
Mailing Address - Fax:425-259-1172
Practice Address - Street 1:4005 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4920
Practice Address - Country:US
Practice Address - Phone:425-339-5468
Practice Address - Fax:425-259-1172
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60253710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60253710OtherLICENSE