Provider Demographics
NPI:1770847295
Name:TITISHINA, SVETLANA G (MD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:G
Last Name:TITISHINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SVIATLANA
Other - Middle Name:G
Other - Last Name:TSITSISHYNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1330 COSHOCTON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-392-0167
Practice Address - Street 1:1330 COSHOCTON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050
Practice Address - Country:US
Practice Address - Phone:740-393-9000
Practice Address - Fax:740-392-0167
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-124508208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics