Individual
LOGAN HENRY FAIRCHILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
420 S 5TH AVE, WEST READING, PA 19611-2143
(484) 628-8269
Mailing address
PO BOX 13579, READING, PA 19612-3579
(484) 628-1324
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
OS022631
PA
390200000X
Student in an Organized Health Care Education/Training Program
OT019238
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS022631
MEDICAL LICENSE
PA
Enumeration date
06/06/2019
Last updated
09/09/2024
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