Provider Demographics
NPI:1679563043
Name:VENABLE, JOHN CLARK JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CLARK
Last Name:VENABLE
Suffix:JR
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 1:1051 W AREBA AVE
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2204
Mailing Address - Country:US
Mailing Address - Phone:717-364-2202
Mailing Address - Fax:
Practice Address - Street 1:1051 W AREBA AVE
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2204
Practice Address - Country:US
Practice Address - Phone:717-364-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069444L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology