Healthcare Provider Details

I. General information

NPI: 1316267750
Provider Name (Legal Business Name): GARETH MURCHISON TITUS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 WILBORN AVE SUITE A
SOUTH BOSTON VA
24592-1662
US

IV. Provider business mailing address

2232 WILBORN AVE SUITE A
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-8977
  • Fax:
Mailing address:
  • Phone: 434-572-8977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD034785
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD27482
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101247857
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: