Provider Demographics
NPI:1972007532
Name:TITELBAUM, NICHOLAS VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:VINCENT
Last Name:TITELBAUM
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 1:50 HURT PLZ SE STE 600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-2915
Mailing Address - Country:US
Mailing Address - Phone:404-616-9237
Mailing Address - Fax:
Practice Address - Street 1:50 HURT PLZ SE STE 600
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-2915
Practice Address - Country:US
Practice Address - Phone:404-616-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
GA87963207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program