Provider Demographics
NPI:1598242174
Name:TITUS-GRANT, ALTHEA M (NP)
Entity Type:Individual
Prefix:
First Name:ALTHEA
Middle Name:M
Last Name:TITUS-GRANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 BERGENIA LOOP
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-4883
Mailing Address - Country:US
Mailing Address - Phone:302-391-4611
Mailing Address - Fax:
Practice Address - Street 1:4051 OGLETOWN RD STE 200
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3101
Practice Address - Country:US
Practice Address - Phone:302-391-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000197207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine