Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JOHNATHAN VITAL, PH.D.
Active Sole ProprietorDR. JOHNATHAN VITAL, PH.D. is a Clinical Neuropsychologist healthcare provider located in WALDORF, Maryland. NPI 1477810067 is currently active in the NPPES registry. Verify at CMS.
Clinical Neuropsychologist · WALDORF, MD
Registration Details
- NPI Number
- 1477810067
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Apr 19, 2012 (14.364777158183 yrs)
- Last Updated
- Apr 20, 2012
- Licenses
-
04759 (MD)04759 (MD)PSY1000614 (DC)PSY1000614 (DC)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2413 ALTENBURG CTWALDORF, MD, 20603Browse MD providers · Browse ZIP 20603
- Phone
- 3016538828
- Fax
- 2025587113
- Primary Specialty
-
Clinical Neuropsychologist
103G00000X
- Additional Specialty
- Psychologist
- Additional Specialty
- Clinical Neuropsychologist
- Additional Specialty
- Psychologist
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.