Provider Demographics
NPI:1619295896
Name:MENENDEZ, VIRGINIA LOGUE (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LOGUE
Last Name:MENENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 CAHABA RD
Mailing Address - Street 2:STE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35223-2629
Mailing Address - Country:US
Mailing Address - Phone:205-870-7292
Mailing Address - Fax:205-638-9996
Practice Address - Street 1:3300 CAHABA RD STE 102
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35223-2629
Practice Address - Country:US
Practice Address - Phone:205-870-7292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL31452208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL150423Medicaid
AL31452OtherSTATE LICENSE NUMBER
AL051133341OtherBLUE SHIELD PROVIDER NUMBER