Healthcare Provider Details

I. General information

NPI: 1316697071
Provider Name (Legal Business Name): LOGAN ALLEN CHESHIRE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 EMILY DR
CLARKSBURG WV
26301-5512
US

IV. Provider business mailing address

339 S MIMOSA LN APT 1
BRIDGEPORT WV
26330-1998
US

V. Phone/Fax

Practice location:
  • Phone: 304-423-5180
  • Fax:
Mailing address:
  • Phone: 301-268-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number000
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4651
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: