Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | SP024036 | PA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | SP024036 | PA |
NPI | 1912570128 |
---|---|
Provider Name | Titus Leitoro |
First Address | Lancaster, PA 17601-4716 |
Second Address | Lebanon, PA 17042-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2021 |
Last Update Date | 16/11/2021 |