Provider Demographics
NPI:1083690036
Name:SLADE-HARTMAN, VENEZELA THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:VENEZELA
Middle Name:THOMAS
Last Name:SLADE-HARTMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4692 BROWNSBORO ROAD
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106
Mailing Address - Country:US
Mailing Address - Phone:336-251-1114
Mailing Address - Fax:336-251-1116
Practice Address - Street 1:4692 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3410
Practice Address - Country:US
Practice Address - Phone:336-251-1114
Practice Address - Fax:336-251-1116
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200201189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB9795OtherMEDCOST
NC080190704OtherRAIL ROAD MEDICARE
NC132TCOtherBCBS
NC4517503001OtherCIGNA HEALTHCARE
NC7035421OtherAETNA NON HMO
NC801186OtherPARTNERS MEDICARE CHOICE
NC89132TCMedicaid
NC280161OtherMAMSI
NC0102939OtherUNITED HEALTHCARE
NC3024671OtherAETNA - HMO
NYB9795OtherMEDCOST
NCH74423Medicare UPIN
NC1212660029Medicare NSC
NC2007995AMedicare PIN