Provider Demographics
NPI:1558466177
Name:VITALE, PATRICIA A (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:VITALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:168 E 5900 S
Mailing Address - Street 2:SUITE C-104
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7282
Mailing Address - Country:US
Mailing Address - Phone:801-261-3007
Mailing Address - Fax:801-263-6703
Practice Address - Street 1:168 E 5900 S
Practice Address - Street 2:SUITE C-104
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7282
Practice Address - Country:US
Practice Address - Phone:801-261-3007
Practice Address - Fax:801-263-6703
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5228084-1205207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology