Provider Demographics
NPI:1841291457
Name:VITEK, JAMES JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:VITEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:
Other - Last Name:VITEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:701 EAST CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646
Mailing Address - Country:US
Mailing Address - Phone:301-609-4000
Mailing Address - Fax:301-609-4311
Practice Address - Street 1:701 EAST CHARLES STREET
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646
Practice Address - Country:US
Practice Address - Phone:301-609-4000
Practice Address - Fax:301-609-4311
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0044492208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD009239S66Medicare ID - Type UnspecifiedINDIVIDUAL PAR NUMBER