Provider Demographics
NPI:1164495537
Name:LITOS, MARTHA T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:T
Last Name:LITOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 758963
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8963
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-217-7991
Practice Address - Street 1:2300 E PARHAM RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3118
Practice Address - Country:US
Practice Address - Phone:804-264-7808
Practice Address - Fax:804-266-2342
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059312207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA013825P95 - C03895Medicare PIN
VAG98576Medicare UPIN
VA080008013Medicare ID - Type Unspecified