Provider Demographics
NPI:1629253323
Name:QUE, VIRGIE U (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGIE
Middle Name:U
Last Name:QUE
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 1:1790 N LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2971
Mailing Address - Country:US
Mailing Address - Phone:419-734-4539
Mailing Address - Fax:419-734-6365
Practice Address - Street 1:1790 N LAKEWOOD AVE
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2971
Practice Address - Country:US
Practice Address - Phone:419-734-4539
Practice Address - Fax:419-734-6365
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-01
Last Update Date:2008-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053050207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine