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Organization

MARK E LOGAN MD PC

Active
Other names
Green Mountain Family Medicine
Organization subpart
No

Provider details

NPI number
Authorized official
MARK E LOGAN MD (OWNER)
(802) 775-7798
Entity
Organization

Contact information

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

Taxonomy

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

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1018281
VT
Enumeration date
11/08/2010
Last updated
01/12/2015
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