MEDICARE: DR. KATHERINE ELIZABETH LOGAN MD

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
1	207Q00000X	Family Medicine Physician	042.0017166	VT

General Provider Information

NPI Number	:	1750905006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE ELIZABETH LOGAN MD

Provider Business Mailing Address
First Line	:	617 RIVERSIDE AVE
Second Line	:
City	:	BURLINGTON
State	:	VT
Zip	:	05401-1601
Country	:	US
Telephone Number	:	401-642-8569
Fax Number	:

Provider Business Practice Location Address
First Line	:	87 MAIN ST
Second Line	:
City	:	ESSEX JUNCTION
State	:	VT
Zip	:	05452-3234
Country	:	US
Telephone Number	:	802-404-1350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	08/19/2025

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