Provider Demographics
NPI:1346708641
Name:TITANWA, FREDDY D
Entity Type:Individual
Prefix:
First Name:FREDDY
Middle Name:D
Last Name:TITANWA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13105 ROSALIES PROGRESS CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6322
Mailing Address - Country:US
Mailing Address - Phone:443-825-5979
Mailing Address - Fax:
Practice Address - Street 1:13105 ROSALIES PROGRESS CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6322
Practice Address - Country:US
Practice Address - Phone:443-825-5979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities