Individual
CASEY DOUGLAS LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2790 MOSSIDE BLVD STE 720, MONROEVILLE, PA 15146-2757
(412) 372-2770
(412) 372-4656
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD479164
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1040784250001
—
PA
05
—
1040784250002
—
PA
Enumeration date
04/20/2018
Last updated
10/31/2024
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