Provider Demographics
NPI:1174717755
Name:VENEZIANO, JOSEPH ALFRED JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ALFRED
Last Name:VENEZIANO
Suffix:JR
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:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:980-212-6250
Mailing Address - Fax:980-212-6251
Practice Address - Street 1:441 MCALISTER RD
Practice Address - Street 2:SUITE 1100A
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4126
Practice Address - Country:US
Practice Address - Phone:980-212-6250
Practice Address - Fax:980-212-6251
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2008-01236207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0123CMedicaid
NC1174717755Medicaid
NC5910093Medicaid
NC2022780Medicare PIN
NCNCI024AMedicare PIN