Healthcare Provider Details

I. General information

NPI: 1295678647
Provider Name (Legal Business Name): NICHOLAS LOGERFO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CTR PL STE 1
BOSTON MA
02118-2999
US

IV. Provider business mailing address

847 S LOGAN ST
DENVER CO
80209-4127
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-8000
  • Fax:
Mailing address:
  • Phone: 253-820-9466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: