=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255159513
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VICTORIA CHIU
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2024
-----------------------------------------------------
Last Update Date | 09/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6220 OLD DOBBIN LN
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21045-5812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-964-8500
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 SHAWAN RD UNIT 371
-----------------------------------------------------
City | COCKEYSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21030-1478
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-825-6561
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | C0009650
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------