Provider Demographics
NPI:1295138477
Name:TITLEMAN ORTHOPEDICS
Entity type:Organization
Organization Name:TITLEMAN ORTHOPEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KEENE
Authorized Official - Suffix:
Authorized Official - Credentials:BOCO
Authorized Official - Phone:215-722-0751
Mailing Address - Street 1:8 N 5TH ST
Mailing Address - Street 2:GROUND FLOOR
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2392
Mailing Address - Country:US
Mailing Address - Phone:215-722-0751
Mailing Address - Fax:
Practice Address - Street 1:700 E TOWNSHIP LINE RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:610-724-3561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA42496672332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7176550001Medicare NSC