Provider Demographics
NPI:1528072360
Name:LITANI, VLADAS (MD)
Entity type:Individual
Prefix:
First Name:VLADAS
Middle Name:
Last Name:LITANI
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 1:100 SOUTH ST
Mailing Address - Street 2:STE 202
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550
Mailing Address - Country:US
Mailing Address - Phone:508-764-4885
Mailing Address - Fax:508-764-4799
Practice Address - Street 1:100 SOUTH ST
Practice Address - Street 2:STE 202
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550
Practice Address - Country:US
Practice Address - Phone:508-764-4885
Practice Address - Fax:508-764-4799
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75869207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075869OtherTUFTS HEALTH PLAN
MA35156OtherCIGNA
MA3095550Medicaid
MA075869OtherTUFTS HEALTH PLAN
MA3095550Medicaid