Provider Demographics
NPI:1962481382
Name:TITUS, C. KENT (MD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:KENT
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 1:2201 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4438
Mailing Address - Country:US
Mailing Address - Phone:804-359-1351
Mailing Address - Fax:804-355-6625
Practice Address - Street 1:2201 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4438
Practice Address - Country:US
Practice Address - Phone:804-359-1351
Practice Address - Fax:804-355-6625
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020690207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6053777Medicaid
111950729Medicare PIN
VA6053777Medicaid