Provider Demographics
NPI:1174551733
Name:EUGENIO, EMMANUEL E (MD)
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:E
Last Name:EUGENIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6372 MECHANICSVILLE TPKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4705
Mailing Address - Country:US
Mailing Address - Phone:804-730-4690
Mailing Address - Fax:804-559-0333
Practice Address - Street 1:6372 MECHANICSVILLE TPKE
Practice Address - Street 2:SUITE 103
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-4705
Practice Address - Country:US
Practice Address - Phone:804-730-4690
Practice Address - Fax:804-559-0333
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2010-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA854726OtherMAMSI
VA006710018Medicaid
VA223542OtherANTHEM BCBS OF VA
VA45912OtherSENTARA
VA270500OtherSOUTHERN HEALTH SERVICES
VAC06193OtherGROUP PTAN
VA4944612OtherCIGNA
VA5488498OtherAETNA LIFE
VA5488498OtherAETNA HMO
VA854726OtherMAMSI