Provider Demographics
NPI:1366689929
Name:VITIELLO, BENEDETTO (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDETTO
Middle Name:
Last Name:VITIELLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 MIDHILL ST
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6138
Mailing Address - Country:US
Mailing Address - Phone:301-263-0678
Mailing Address - Fax:
Practice Address - Street 1:5801 MIDHILL ST
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6138
Practice Address - Country:US
Practice Address - Phone:301-263-0678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD390922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E63870Medicare UPIN
VI441122Medicare PIN