Provider Demographics
NPI:1770242299
Name:TITUS, WAYNE ROBERT
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ROBERT
Last Name:TITUS
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 1:10608 WYLD DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4648
Mailing Address - Country:US
Mailing Address - Phone:301-641-1277
Mailing Address - Fax:
Practice Address - Street 1:5323 E ST SE APT 372
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6078
Practice Address - Country:US
Practice Address - Phone:202-583-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide