# MARK E LOGAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Green Mountain Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003117078
- **Authorized official:** MARK E LOGAN MD (OWNER)
- **Authorized official phone:** (802) 775-7798

## Contact information

- **Practice address:** 199 STRATTON RD, RUTLAND, VT 05701-4621
- **Practice address phone:** (802) 775-7798
- **Practice address fax:** (802) 775-7762
- **Mailing address:** 199 STRATTON RD, RUTLAND, VT 05701-4621
- **Mailing address phone:** (802) 775-7798
- **Mailing address fax:** (802) 775-7762

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RA0401X | Addiction Medicine (Internal Medicine) Physician | 042-0006819 | VT | Yes |

## Other

- **Enumeration date:** 11/08/2010
- **Last updated:** 01/12/2015