Provider Demographics
NPI:1285694943
Name:VITALE, JOSEPH ANTHONY (DO)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:VITALE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:MAP 2 SUITE 1116
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-368-1562
Mailing Address - Fax:302-368-8836
Practice Address - Street 1:4735 OGLETOWN STANTON RD
Practice Address - Street 2:MAP 2 SUITE 1116
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2072
Practice Address - Country:US
Practice Address - Phone:302-368-1562
Practice Address - Fax:302-368-8836
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE510110041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE783F23OtherBC/BS DE PCP #
DEK899OtherBC/BS MD PCP #
DE0000022203OtherDELAWARE PHYSICIANS CARE
DE0000022203OtherDIAMOND STATE HEALTH (DE
DE0075294000OtherAMERIHEALTH - HMO
DE44567OtherCOVENTRY HEALTH CARE
DE000059475OtherINDEPENDENCE BLUE CROSS -
DE0075294000Other0075294000
DE059475OtherAMERIHEALTH - PPO
DEC48581OtherMID-ATLANTIC
DE0000022203Medicaid
DE4285988OtherAETNA USHC
DE856327OtherMAMSI PROVIDER #
DE856327OtherMAMSI PROVIDER #
DE59475Medicare ID - Type Unspecified