Healthcare Provider Details

I. General information

NPI: 1528072360
Provider Name (Legal Business Name): VLADAS LITANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SOUTH ST STE 202
SOUTHBRIDGE MA
01550
US

IV. Provider business mailing address

100 SOUTH ST STE 202
SOUTHBRIDGE MA
01550
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-4885
  • Fax: 508-764-4799
Mailing address:
  • Phone: 508-764-4885
  • Fax: 508-764-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75869
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number75869
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: