Provider Demographics
NPI:1548452147
Name:VITALI, ARIEL ANTONIO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ANTONIO
Last Name:VITALI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:VITALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6501 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-6819
Mailing Address - Country:US
Mailing Address - Phone:410-938-3461
Mailing Address - Fax:410-938-5131
Practice Address - Street 1:4100 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:443-364-5500
Practice Address - Fax:443-364-5501
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD803202084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD379005301Medicaid