Provider Demographics
NPI:1427041714
Name:MENENDEZ, GREGORY (AA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:MENENDEZ
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-8996
Mailing Address - Fax:216-636-2043
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-4073
Practice Address - Country:US
Practice Address - Phone:216-444-8986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH67000018367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000515970OtherANTHEM
OH0583328OtherBCMH
OH2491021Medicaid
OH415010OtherWELLCARE MEDICAID
OHP00405856OtherMEDICARE RAILROAD
OH7405896OtherAETNA
OH000000232169OtherUNISON
MI1427041714Medicaid
OHME4120402Medicare PIN
OHME4120406Medicare PIN