Healthcare Provider Details

I. General information

NPI: 1073109542
Provider Name (Legal Business Name): KENT ALEXANDER LOGAN MD NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 HIGH ST STE 301
HAMPTON NH
03842-2213
US

IV. Provider business mailing address

55 HIGH ST STE 301
HAMPTON NH
03842-2213
US

V. Phone/Fax

Practice location:
  • Phone: 603-601-7762
  • Fax:
Mailing address:
  • Phone: 603-601-7762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KENT A LOGAN
Title or Position: OWNER
Credential: MD
Phone: 603-601-7762