Provider Demographics
NPI:1437198033
Name:TITUS, PATRICK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:ALLEN
Last Name:TITUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-1731
Mailing Address - Country:US
Mailing Address - Phone:302-422-5506
Mailing Address - Fax:302-422-5507
Practice Address - Street 1:909 LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-1731
Practice Address - Country:US
Practice Address - Phone:302-422-5506
Practice Address - Fax:302-422-5507
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006175207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000036970Medicaid
DEI2726IMedicare UPIN
DEG01919L01Medicare PIN