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General NPI Number Information
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NPI Number | 1316697071
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Entity Type | Individual
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Provider Name | LOGAN ALLEN CHESHIRE DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2022
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 469 EMILY DR
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City | CLARKSBURG
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State | WV
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Zip | 26301-5512
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Country | US
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Telephone | 304-423-5180
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Fax |
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Provider Business Mailing Address
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Address Line | 339 S MIMOSA LN APT 1
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1998
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Country | US
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Telephone | 301-268-2392
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 000
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4651
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License Number State | WV
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