Provider Demographics
NPI:1548452147
Name:VITALI, ARIEL ANTONIO JR (MD)
Entity type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:ANTONIO
Last Name:VITALI
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARIEL
Other - Middle Name:
Other - Last Name:VITALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5850 WATERLOO RD STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1943
Mailing Address - Country:US
Mailing Address - Phone:410-757-2077
Mailing Address - Fax:
Practice Address - Street 1:5850 WATERLOO RD STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1943
Practice Address - Country:US
Practice Address - Phone:410-757-2077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00803202084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD379005301Medicaid