Provider Demographics
NPI:1750336855
Name:VENABLE, ROBERT LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:VENABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-0669
Mailing Address - Country:US
Mailing Address - Phone:252-209-0237
Mailing Address - Fax:252-209-0197
Practice Address - Street 1:9500 NC HIGHWAY 94 N
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:NC
Practice Address - Zip Code:27928-8300
Practice Address - Country:US
Practice Address - Phone:252-797-0135
Practice Address - Fax:833-755-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22192208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-84900Medicaid
NC84900OtherBCBS
NC89-84900Medicaid
NCC85479Medicare UPIN