Provider Demographics
NPI:1003489956
Name:TITA, RITA TIFUH X (MD)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:TIFUH
Last Name:TITA
Suffix:X
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:RITA
Other - Middle Name:TIFUH
Other - Last Name:TITA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5908 KING ARTHUR WAY
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-8908
Mailing Address - Country:US
Mailing Address - Phone:661-616-7527
Mailing Address - Fax:
Practice Address - Street 1:5908 KING ARTHUR WAY
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-8908
Practice Address - Country:US
Practice Address - Phone:661-616-7527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA15518374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HHA15518OtherHHA
DCHHA15518OtherHHA
DCHHA15518Medicaid