Provider Demographics
NPI:1053410530
Name:VINITSKY, ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:VINITSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 WIND RIVER LANE STE 201
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-1977
Mailing Address - Country:US
Mailing Address - Phone:301-840-0002
Mailing Address - Fax:301-417-0262
Practice Address - Street 1:902 WIND RIVER LN STE 201
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1977
Practice Address - Country:US
Practice Address - Phone:301-840-0002
Practice Address - Fax:301-417-0262
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522350226OtherTAX-ID #
MD763431500Medicaid
MDD0022180OtherDPT OF HEALTH & MENTAL HY
MD763431500Medicaid
MDD0022180OtherDPT OF HEALTH & MENTAL HY