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Individual

LISA S LOGAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
301 SAINT PAUL PL, DEPARTMENT OF PATHOLOGY, BALTIMORE, MD 21202-2102
(410) 332-9882
(410) 234-2558
Mailing address
PO BOX 64075, BALTIMORE, MD 21264-4075

Taxonomy

Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
D0050769
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
KU59ST / 600433-01
BC / BS OF MD
MD
01
S185 / 0014
BLUECHOICE
MD
01
S797 / S797
BC / BS OF MD
MD
Enumeration date
06/21/2006
Last updated
07/08/2007
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