MEDICARE: DR. ARIEL ANTONIO VITALI JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	D0080320	MD
2	2084P0800X	Psychiatry Physician	D0080320	MD

General Provider Information

NPI Number	:	1548452147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARIEL ANTONIO VITALI JR. MD

Provider Business Mailing Address
First Line	:	5850 WATERLOO RD STE 230
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1943
Country	:	US
Telephone Number	:	410-757-2077
Fax Number	:

Provider Business Practice Location Address
First Line	:	5850 WATERLOO RD STE 230
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21045-1943
Country	:	US
Telephone Number	:	410-757-2077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	07/10/2025

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