Individual
DR. GINA GENOVEFFA VITIELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
47 CONCETTA SASS DR, RANDOLPH, MA 02368-1812
(781) 767-3276
(781) 767-3276
Mailing address
680 CENTRE ST, ATTN: PROVIDER ENROLLMENT, BROCKTON, MA 02302-3308
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
—
—
2084P0800X
Psychiatry Physician
Primary
159786
MA
Other
Enumeration date
06/24/2006
Last updated
05/05/2020
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