Individual
DR. JONATHAN LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 PARRISH ST, CANANDAIGUA, NY 14424-1727
(585) 394-6070
Mailing address
201 PARRISH ST, CANANDAIGUA, NY 14424-1727
(585) 394-6070
(585) 394-3068
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
089645
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00025452201
UNIVERA
NY
01
—
030001160
RAILROAD MEDICARE
NY
01
—
100497AA
PREFERRED CARE AL
NY
01
—
100497DT
PREFERRED CARE PA
NY
01
—
1360
EXCELLUS BLUE SHIELD
NY
01
—
5176319
AETNA
NY
01
—
P010089546
EXCELLUS BLUE CHOICE
NY
Enumeration date
06/16/2005
Last updated
01/26/2010
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