Provider Demographics
NPI:1124065966
Name:TITUS, AJEEB JOHN (MD)
Entity type:Individual
Prefix:
First Name:AJEEB
Middle Name:JOHN
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 1:2591 BAGLYOS CIR
Mailing Address - Street 2:SUITE C-50
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8027
Mailing Address - Country:US
Mailing Address - Phone:484-821-0203
Mailing Address - Fax:484-821-0214
Practice Address - Street 1:2591 BAGLYOS CIR
Practice Address - Street 2:SUITE C-50
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8027
Practice Address - Country:US
Practice Address - Phone:484-821-0203
Practice Address - Fax:484-821-0214
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068349L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00323966OtherMEDICARE RAILROAD
NJ074091Medicare PIN
PA049102Medicare PIN
H41202Medicare UPIN