Provider Demographics
NPI:1295925691
Name:VITO, RICHARD ANTHONY (MD, FACEP)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:VITO
Suffix:
Gender:M
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 COLLEGE AVE # 324
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7301
Mailing Address - Country:US
Mailing Address - Phone:303-499-5949
Mailing Address - Fax:
Practice Address - Street 1:100 CALLE 2
Practice Address - Street 2:WASH N POST - 132
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4274
Practice Address - Country:US
Practice Address - Phone:787-460-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-31
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24800207P00000X
NY154145-1207P00000X
PR008922207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E45170Medicare UPIN