Provider Demographics
NPI:1104812940
Name:VENIT, BETHANY ANNE (MD)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:ANNE
Last Name:VENIT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-1837
Mailing Address - Country:US
Mailing Address - Phone:570-455-8557
Mailing Address - Fax:570-459-6832
Practice Address - Street 1:881 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-1837
Practice Address - Country:US
Practice Address - Phone:570-455-8557
Practice Address - Fax:570-459-6832
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016940E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006134960002Medicaid
2511775OtherAETNA
027557OtherBS
001024OtherFPH
16321OtherGHP