Provider Demographics
NPI:1811064819
Name:CASERTA, VITO MARCELLO (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:VITO
Middle Name:MARCELLO
Last Name:CASERTA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 RUNNING SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-5820
Mailing Address - Country:US
Mailing Address - Phone:301-371-4006
Mailing Address - Fax:
Practice Address - Street 1:6820 RUNNING SPRINGS CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-5820
Practice Address - Country:US
Practice Address - Phone:301-371-4006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2016-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 038027E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics