Healthcare Provider Details

I. General information

NPI: 1548452147
Provider Name (Legal Business Name): ARIEL ANTONIO VITALI JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ARIEL VITALI MD

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5850 WATERLOO RD STE 230
COLUMBIA MD
21045-1943
US

IV. Provider business mailing address

5850 WATERLOO RD STE 230
COLUMBIA MD
21045-1943
US

V. Phone/Fax

Practice location:
  • Phone: 410-757-2077
  • Fax:
Mailing address:
  • Phone: 410-757-2077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0080320
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0080320
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: