Basic Information
| Provider Information | |||||||||
| NPI: | 1558445726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VITALE | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | PAUROSO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1060 DAY HILL RD | ||||||||
| Address2: | |||||||||
| City: | WINDSOR | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060955719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606832690 | ||||||||
| FaxNumber: | 8606832670 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 JEFFERSON RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5854131800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 045663 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 292050 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1558445726 | 01 | CT | NPI | OTHER |