Provider Demographics
NPI:1669545604
Name:VENEZIA, MARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:VENEZIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 42
Mailing Address - Street 2:126 SWEDESFORD RD
Mailing Address - City:GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19436-0042
Mailing Address - Country:US
Mailing Address - Phone:215-699-0106
Mailing Address - Fax:215-699-1206
Practice Address - Street 1:833 WEST BUTLER AVE
Practice Address - Street 2:FOUNDATIONS BEHAVIORAL HEALTH
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-0444
Practice Address - Fax:215-699-1206
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD028798E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1194357Medicaid
PA1194357Medicaid