Provider Demographics
NPI:1104867811
Name:MENEZ, EUGENIO ALDEA (MD)
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:ALDEA
Last Name:MENEZ
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 1:1714 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1321
Mailing Address - Country:US
Mailing Address - Phone:304-363-3714
Mailing Address - Fax:304-363-6850
Practice Address - Street 1:1714 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1321
Practice Address - Country:US
Practice Address - Phone:304-363-3714
Practice Address - Fax:304-363-6850
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F38309Medicare UPIN