MEDICARE: DR. SAMUEL CAREY VENTURELLA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MMD.36157TL	SC

General Provider Information

NPI Number	:	1902006794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL CAREY VENTURELLA M.D.

Provider Business Mailing Address
First Line	:	1156 EDGEFIELD ST
Second Line	:	UPPER SAVANNAH RADIOLOGIC ASSOCIATES
City	:	GREENWOOD
State	:	SC
Zip	:	29646
Country	:	US
Telephone Number	:	864-889-9605
Fax Number	:

Provider Business Practice Location Address
First Line	:	1156 EDGEFIELD ST
Second Line	:	UPPER SAVANNAH RADIOLOGIC ASSOCIATES
City	:	GREENWOOD
State	:	SC
Zip	:	29646
Country	:	US
Telephone Number	:	864-889-9605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2007
Last Update Date	:	07/31/2013

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