Provider Demographics
NPI:1518168160
Name:DONTY, VENKATESH BABU (MD)
Entity Type:Individual
Prefix:DR
First Name:VENKATESH BABU
Middle Name:
Last Name:DONTY
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:PO BOX 19036
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:903-758-1464
Mailing Address - Fax:
Practice Address - Street 1:709 HOLLYBROOK DR STE 3400
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2412
Practice Address - Country:US
Practice Address - Phone:903-758-1464
Practice Address - Fax:903-758-4366
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2062207RP1001X
IL036-105505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13774Medicare UPIN
ILRES 000Medicare UPIN
ILH 55934Medicare UPIN