MEDICARE: DR. MARIE PAUROSO VITALE 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	207Q00000X	Family Medicine Physician	045663	CT
2	207Q00000X	Family Medicine Physician	292050	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558445726	OTHER	CT	NPI

General Provider Information

NPI Number	:	1558445726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE PAUROSO VITALE MD

Provider Business Mailing Address
First Line	:	1060 DAY HILL RD
Second Line	:
City	:	WINDSOR
State	:	CT
Zip	:	06095-5719
Country	:	US
Telephone Number	:	860-683-2690
Fax Number	:	860-683-2670

Provider Business Practice Location Address
First Line	:	1300 JEFFERSON RD
Second Line	:	SUITE 100
City	:	ROCHESTER
State	:	NY
Zip	:	14623
Country	:	US
Telephone Number	:	585-413-1800
Fax Number	:

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	06/30/2023

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