Provider Demographics
NPI:1316923683
Name:TITUS, BENNY E (MD)
Entity type:Individual
Prefix:
First Name:BENNY
Middle Name:E
Last Name:TITUS
Suffix:
Gender:F
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:18020-8043
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:18020-8043
Practice Address - Country:US
Practice Address - Phone:484-821-0253
Practice Address - Fax:484-821-0214
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA073928002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0070173Medicaid
NJ0070173Medicaid
NJ072418Medicare ID - Type Unspecified