Provider Demographics
NPI:1821083932
Name:CHIU, MARK T (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:T
Last Name:CHIU
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-246-2478
Practice Address - Street 1:806 DR MARTIN LUTHER KING JR AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3657
Practice Address - Country:US
Practice Address - Phone:505-842-6575
Practice Address - Fax:505-764-8796
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-04-25
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Provider Licenses
StateLicense IDTaxonomies
NM88-17207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM000562OtherBC BS OF NM
AZ279522Medicaid
NM05140Medicaid
NM180014486OtherMEDICARE ID
CO91-088179Medicaid
NM05140Medicaid
CO91-088179Medicaid