Provider Demographics
NPI:1023293792
Name:ELIZABETH M. VENNOS, MD
Entity type:Organization
Organization Name:ELIZABETH M. VENNOS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:VENNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-647-2188
Mailing Address - Street 1:2075 BARKLEY BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-6697
Mailing Address - Country:US
Mailing Address - Phone:360-647-2188
Mailing Address - Fax:
Practice Address - Street 1:2075 BARKLEY BLVD STE 230
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6697
Practice Address - Country:US
Practice Address - Phone:360-647-2188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB29599Medicare PIN