Healthcare Provider Details

I. General information

NPI: 1194285932
Provider Name (Legal Business Name): LOGAN ROBERT HOLLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2001
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVENUE ML 2001
CINCINNATI OH
45229-0293
US

V. Phone/Fax

Practice location:
  • Phone: 440-390-0868
  • Fax:
Mailing address:
  • Phone: 440-390-0868
  • Fax: 859-323-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number35.147615
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: