Provider Demographics
NPI:1740268754
Name:VITELLI, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:VITELLI
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 1:345 BLACKSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4800
Mailing Address - Country:US
Mailing Address - Phone:401-455-6362
Mailing Address - Fax:
Practice Address - Street 1:345 BLACKSTONE BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4800
Practice Address - Country:US
Practice Address - Phone:401-455-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD08534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RIP00434711OtherMEDICARE RAILRAOD
RI1104801349OtherBUTLER HOSPITAL NPI
RI20333-3OtherBLUE CROSS
RI22860-8OtherBCBS - MIRIAM
RI04-03704OtherUNITED HEALTHCARE
RI7008653Medicaid
RI408074OtherBLUE CHIP
RI119023709OtherMEDICARE ID-TYPE UNSPECIFIED
RIP00434711OtherMEDICARE RAILRAOD
RIE59658Medicare UPIN