Provider Demographics
NPI:1114962719
Name:VENUTI, FRANK JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:JOSEPH
Last Name:VENUTI
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 1:165 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-8202
Mailing Address - Country:US
Mailing Address - Phone:423-869-7193
Mailing Address - Fax:423-869-7195
Practice Address - Street 1:165 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752-8202
Practice Address - Country:US
Practice Address - Phone:423-869-7193
Practice Address - Fax:423-869-7195
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182936-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251321Medicaid
NY01251321Medicaid
C65548Medicare UPIN
NYDD4893Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE