Provider Demographics
NPI:1023002037
Name:VENERO, JOSE VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:VICENTE
Last Name:VENERO
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 1:125 N FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5892
Mailing Address - Country:US
Mailing Address - Phone:724-223-3713
Mailing Address - Fax:724-229-2429
Practice Address - Street 1:125 N FRANKLIN DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5892
Practice Address - Country:US
Practice Address - Phone:724-225-6500
Practice Address - Fax:724-229-2170
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87582207R00000X
PAMD431957207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268238900Medicaid
FL71003OtherBCBS
FL71003ZMedicare ID - Type Unspecified
H86534Medicare UPIN