Basic Information
| Provider Information | |||||||||
| NPI: | 1588972384 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VITUCCI | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 W GERMANTOWN PIKE | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194011385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102720190 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2705 DEKALB PIKE STE 202 | ||||||||
| Address2: | |||||||||
| City: | EAST NORRITON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102757240 | ||||||||
| FaxNumber: | 6102750633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2010 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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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 | OS015920 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.