Provider Demographics
NPI:1063627693
Name:VITIELLO, ANGELA L (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:L
Last Name:VITIELLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33475 N DEER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5200
Mailing Address - Country:US
Mailing Address - Phone:216-533-2763
Mailing Address - Fax:
Practice Address - Street 1:8819 COMMONS BLVD # 200
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2177
Practice Address - Country:US
Practice Address - Phone:330-405-9147
Practice Address - Fax:330-405-9884
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.008648208000000X
OH35-092276208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022579640001Medicaid
OH2869150Medicaid
PA1022579640001Medicaid
OHHA4245721Medicare PIN