Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Johnathan Vital, PHD

Individual provider Clinical Neuropsychologist · NPI 1477810067

Dr. Johnathan Vital, PHD is a Clinical Neuropsychologist in Waldorf, Maryland. Practices as a sole proprietor. Licensed in District of Columbia and Maryland.

Licensed in
DC, MD
In the registry since
2012
Specialties on file
4
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

See every abbreviation used in this directory →

Practice location Address checks out

2413 Altenburg Ct
Waldorf, MD 20603
Phone: (301) 653-8828
Fax: (202) 558-7113
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Neuropsychologist (primary) Taxonomy 103G00000X · Licence 04759 (MD)
Psychologist Taxonomy 103T00000X · Licence 04759 (MD)
Clinical Neuropsychologist Taxonomy 103G00000X · Licence PSY1000614 (DC)
Psychologist Taxonomy 103T00000X · Licence PSY1000614 (DC)

Record details

NPI number1477810067
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD
Sole proprietorYes
NPI enumeratedApril 19, 2012
Last updated in NPPESApril 20, 2012
Mailing address2413 Altenburg Ct, Waldorf, MD 20603