Provider Demographics
NPI:1790771814
Name:VENEGONI, PAOLO V (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:V
Last Name:VENEGONI
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 1:5301 RIATA PARK CT
Mailing Address - Street 2:BLDG D SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3437
Mailing Address - Country:US
Mailing Address - Phone:512-617-6000
Mailing Address - Fax:512-615-0459
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLDG 2 STE. 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-617-6000
Practice Address - Fax:512-339-7838
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3645207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132282807Medicaid
TX132282809Medicaid
TX060064377OtherMEDICARE RAILROAD
TX060064377OtherMEDICARE RAILROAD
TX8L14996Medicare PIN
TX89673NMedicare PIN
TX132282807Medicaid
TX8J7493Medicare PIN