Provider Demographics
NPI:1861549651
Name:TITOVA, DINA (MD)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:TITOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11311 BRIDGEPORT WAY SW
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-3071
Mailing Address - Country:US
Mailing Address - Phone:253-985-6490
Mailing Address - Fax:
Practice Address - Street 1:11311 BRIDGEPORT WAY SW
Practice Address - Street 2:SUITE 214
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-3071
Practice Address - Country:US
Practice Address - Phone:253-985-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048351207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA222634OtherSTATE L&I
WA222635OtherSTATE L&I
WAG8866496Medicare PIN
WA222634OtherSTATE L&I