Provider Demographics
NPI:1053436923
Name:TITUS, REBIN THOMAS (MD)
Entity type:Individual
Prefix:
First Name:REBIN
Middle Name:THOMAS
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 1:2602 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1010
Mailing Address - Country:US
Mailing Address - Phone:540-344-1400
Mailing Address - Fax:540-344-1491
Practice Address - Street 1:2602 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-344-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249223207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053436923OtherUNITED HEALTHCARE / MAMSI
VA1053436923Medicaid
NC5917782Medicaid
VA1053436923OtherANTHEM
VA1053436923OtherGATEWAY HEALTH ALLIANCE
VA1053436923OtherHEALTHNET FEDERAL SERVICES / TRICARE
VA5998251OtherCIGNA
VAVV2278AMedicare PIN