Provider Demographics
NPI:1104802792
Name:TITUS, ALBERT A (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:A
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 1:9086 PETERS REST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-5617
Mailing Address - Country:US
Mailing Address - Phone:340-715-7779
Mailing Address - Fax:
Practice Address - Street 1:4500 SUNNY ISLE STE 26B
Practice Address - Street 2:
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4493
Practice Address - Country:US
Practice Address - Phone:340-715-7779
Practice Address - Fax:877-451-0296
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80817208600000X
VI1613208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35818OtherBLUE CROSS BLUE SHIELD
FL259382300Medicaid
H29494Medicare UPIN
FL259382300Medicaid
FL35818XMedicare PIN