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NPI Code Detail

MEDICARE: DR. KRISTIN MARIE LOGEE D.O.

MEDICARE: DR. KRISTIN MARIE LOGEE D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RR0500XRheumatology Physician052967CT
2207RR0500XRheumatology Physician289661NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336376516
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTIN MARIE LOGEE D.O.
Provider Business Mailing Address
First Line : 263 FARMINGTON AVE
Second Line : PROVIDER ENROLLMENT
City : FARMINGTON
State : CT
Zip : 06030-2212
Country : US
Telephone Number : 860-679-2160
Fax Number : 860-679-1042
Provider Business Practice Location Address
First Line : 4068 ALBANY POST RD
Second Line :
City : HYDE PARK
State : NY
Zip : 12538-3900
Country : US
Telephone Number : 845-229-2123
Fax Number : 845-229-6313
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2009
Last Update Date : 03/17/2018

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