Provider Demographics
NPI:1902102957
Name:QUICHO, EUNICE GAIL VIRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:EUNICE GAIL
Middle Name:VIRAY
Last Name:QUICHO
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 1:400 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2433
Mailing Address - Country:US
Mailing Address - Phone:330-344-5995
Mailing Address - Fax:
Practice Address - Street 1:99 NORTHLINE CIR STE 215
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1481
Practice Address - Country:US
Practice Address - Phone:216-383-2834
Practice Address - Fax:216-383-2923
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35097597207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0050144Medicaid