Individual
LOGAN HARRISON ROBERTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11110 MEDICAL CAMPUS RD STE 200, HAGERSTOWN, MD 21742-6797
(301) 714-4400
Mailing address
11110 MEDICAL CAMPUS RD STE 200, HAGERSTOWN, MD 21742-6797
(301) 714-4400
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C08038
MD
363AM0700X
Medical Physician Assistant
Primary
C0008038
MD
390200000X
Student in an Organized Health Care Education/Training Program
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—
Other
Enumeration date
03/31/2020
Last updated
11/10/2021
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