Provider Demographics
NPI:1306012745
Name:PETER A VITULLI JR D O P A
Entity Type:Organization
Organization Name:PETER A VITULLI JR D O P A
Other - Org Name:A CENTER FOR DERMATOLOGY COSMETIC AND LASER SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:VITULLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:561-427-2000
Mailing Address - Street 1:4600 MILITARY TRL
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4810
Mailing Address - Country:US
Mailing Address - Phone:561-427-2000
Mailing Address - Fax:561-776-2565
Practice Address - Street 1:4600 MILITARY TRL
Practice Address - Street 2:SUITE 107
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4810
Practice Address - Country:US
Practice Address - Phone:561-427-2000
Practice Address - Fax:561-776-2565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8005207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL81700OtherMEDICARE- ID TYPE
FLF75867Medicare UPIN