Provider Demographics
NPI:1093730327
Name:HARTE-TITUS, VIRGINIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:
Last Name:HARTE-TITUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9649 BELAIR RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-1100
Mailing Address - Country:US
Mailing Address - Phone:410-248-2642
Mailing Address - Fax:410-248-2656
Practice Address - Street 1:110 BAUGHMANS LN
Practice Address - Street 2:SUITE 270
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4059
Practice Address - Country:US
Practice Address - Phone:301-846-0300
Practice Address - Fax:301-662-6047
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01045363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
250442OtherKAISER
MD93485Medicaid
012171OtherJOHNS HOPKINS HEALTHCARE
961574OtherNCPPO
961574OtherNCPPO