Provider Demographics
NPI:1912903170
Name:VENABLE, PHILLIP A (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:A
Last Name:VENABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7757 AUBURN RD STE 15
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9604
Mailing Address - Country:US
Mailing Address - Phone:440-350-0832
Mailing Address - Fax:440-579-0191
Practice Address - Street 1:7007 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5437
Practice Address - Country:US
Practice Address - Phone:440-350-0832
Practice Address - Fax:440-579-0191
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35079045V207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2291729Medicaid
OH4066491Medicare PIN
OHG80832Medicare UPIN