Individual
DR. MARK EDWARD LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
042-0006819
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005483
—
VT
01
—
042-0006819
LICENSE
VT
01
—
61-1488339
TAX ID
VT
Enumeration date
05/24/2006
Last updated
06/09/2011
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