Provider Demographics
NPI:1639461411
Name:VITALE, JONATHAN JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JOSEPH
Last Name:VITALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 WESTPARK DR STE 180
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5063
Mailing Address - Country:US
Mailing Address - Phone:615-610-6754
Mailing Address - Fax:
Practice Address - Street 1:109 WESTPARK DR STE 180
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5063
Practice Address - Country:US
Practice Address - Phone:615-610-6754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine