DR. JOHNATHAN VITAL PH.D. NPI 1477810067

NPI Information

  • NPI: 1477810067
  • Provider Name: DR. JOHNATHAN VITAL, PH.D.
  • Classification: Clinical Neuropsychologist - 103G00000X
  • Entity Type: Individual
  • Address: 2413 ALTENBURG CT
    WALDORF, MD
    ZIP 20603
  • Phone: (301) 653-8828

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NPI Details

DR. Johnathan Vital, PH.D. is a clinical neuropsychologist in Waldorf, MD. The provider is a clinical psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The specialty is dedicated to enhancing the understanding of brain-behavior relationships and the application of such knowledge to human problems. DR. Johnathan Vital, PH.D. NPI is 1477810067. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2413 ALTENBURG CT
WALDORF, MD
ZIP 20603
Phone: (301) 653-8828
Fax: (202) 558-7113

The enumeration date for this NPI number is 4/19/2012 and was last updated on 4/20/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103G00000XClinical NeuropsychologistPSY1000614DISTRICT OF COLUMBIANo
2103T00000XPsychologistPSY1000614DISTRICT OF COLUMBIANo
3103T00000XPsychologist04759MARYLANDNo
4103G00000XClinical Neuropsychologist04759MARYLANDYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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