Provider Demographics
NPI:1588609119
Name:VENERO, CARMELO V (MD)
Entity type:Individual
Prefix:
First Name:CARMELO
Middle Name:V
Last Name:VENERO
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 1:1940 ALCOA HWY
Mailing Address - Street 2:SUITE E 310
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-2244
Mailing Address - Country:US
Mailing Address - Phone:865-544-2800
Mailing Address - Fax:
Practice Address - Street 1:1940 ALCOA HWY
Practice Address - Street 2:SUITE E 310
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2244
Practice Address - Country:US
Practice Address - Phone:865-544-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039041207R00000X
TN43974207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001390418Medicaid
TN1031064216OtherMEDICARE PTAN
TN1031064216OtherMEDICARE PTAN
CT001390418Medicaid
CTH26091Medicare UPIN