Healthcare Provider Details

I. General information

NPI: 1144525999
Provider Name (Legal Business Name): MAI TING, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 W DON DIEGO AVE
SANTA FE NM
87505-1683
US

IV. Provider business mailing address

1037 W DON DIEGO AVE
SANTA FE NM
87505-1683
US

V. Phone/Fax

Practice location:
  • Phone: 505-820-1200
  • Fax:
Mailing address:
  • Phone: 505-820-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number81-130
License Number StateNM

VIII. Authorized Official

Name: DR. MARILYN TING
Title or Position: PRESIDENT
Credential: MD
Phone: 505-820-1200